Individual
MARIO JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN, PMHNP-BC
Contact information
Practice address
12900 LAKE AVE APT 1101, LAKEWOOD, OH 44107-1552
(216) 269-8527
Mailing address
12900 LAKE AVE APT 1101, LAKEWOOD, OH 44107-1552
(216) 269-8527
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN416819
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN.CNP.0034613
OH
Other
Enumeration date
10/14/2016
Last updated
08/17/2023
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