Provider Demographics
NPI:1366777203
Name:JORDAN, TERI-LYN (LPN)
Entity type:Individual
Prefix:MRS
First Name:TERI-LYN
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:TERI-LYN
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:9 WEBSTER CT
Mailing Address - Street 2:APT. #1
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-2348
Mailing Address - Country:US
Mailing Address - Phone:607-343-7618
Mailing Address - Fax:
Practice Address - Street 1:9 WEBSTER CT
Practice Address - Street 2:APT. #1
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-2348
Practice Address - Country:US
Practice Address - Phone:607-343-7618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290431-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse