Individual
JORDAN DIANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AGNP
Contact information
Practice address
7630 SOUTHERN BLVD, YOUNGSTOWN, OH 44512-5633
(330) 729-8000
Mailing address
7630 SOUTHERN BLVD, YOUNGSTOWN, OH 44512-5633
(330) 729-8000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN.CNP.0029271
OH
363LG0600X
Gerontology Nurse Practitioner
APRN.CNP.0029271
OH
364SA2200X
Adult Health Clinical Nurse Specialist
APRN.CNP.0029271
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0453891
—
OH
Enumeration date
07/09/2021
Last updated
08/26/2021
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