Individual
JORDAN KIYAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
511 E COLUMBUS AVE, SPRINGFIELD, MA 01105-2506
(413) 733-3488
Mailing address
511 E COLUMBUS AVE, SPRINGFIELD, MA 01105-2506
(413) 733-3488
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN100544
MA
Other
Enumeration date
07/20/2022
Last updated
06/26/2023
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