Individual
STEPHANIE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9500 CAMPCREEK RD, LUCASVILLE, OH 45648
(740) 981-4844
Mailing address
9500 CAMPCREEK RD, LUCASVILLE, OH 45648
(740) 981-4844
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
2527902
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2527902
—
OH
Enumeration date
07/16/2014
Last updated
07/20/2014
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