Most Relevant Information
Provider Data
| NPI Number: | 1003255266 |
| Provider Name: | CRYSTAL MARIE JORDAN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | COA.14867-NP |
Most Important Dates
| Enumeration Date: | 06/20/2013 |
| Last Updated: | 12/13/2022 |
Provider Practice Location
901 WASHINGTON ST
PORTSMOUTH
OH
456623944
Practice Location Phone/Fax
| Phone: | 7403541010 |
| Fax: |
Provider Mailing Location
901 WASHINGTON ST
PORTSMOUTH
OH
456623944
Provider Mailing Phone/Fax
| Phone: | 7403547702 |
| Fax: | 7403531662 |