Individual
MR. NOAH SETH JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1900 EXETER RD, SUITE 210, GERMANTOWN, TN 38138-2954
(901) 818-2160
(901) 682-9522
Mailing address
1900 EXETER RD, SUITE 210, GERMANTOWN, TN 38138-2954
(901) 818-2160
(901) 682-9522
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN 161854
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
APN 16754
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06622859
—
MS
05
—
1529226
—
TN
01
—
1831456177
CHAMPUS/TRICARE
TN
05
—
193841001
—
AR
01
—
4326610
BCBSTN
TN
Enumeration date
04/11/2012
Last updated
04/10/2013
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