Individual
RENALDO JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
(228) 497-0690
Mailing address
3407 SHAMROCK CT, GAUTIER, MS 39553-5337
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R901599
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018214
—
MS
Enumeration date
11/01/2016
Last updated
11/01/2016
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