Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1417539883 |
---|---|
Provider Name | Tiffany Jordan |
First Address | Columbus, OH 43211-2058 |
Second Address | Columbus, OH 43232-4204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2021 |
Last Update Date | 26/04/2021 |