Jordan, Renaldo

Jordan, Renaldo is an individual health care provider with primary practice located at 3407 Shamrock Ct , Gautier MS 39553-5337. He recently has only one registered license in Nursing Service Providers / Registered Nurse, which is considered as his primary health care specialty. Jordan, Renaldo can be contacted via phone (228) 497-0690.

Contact Information

Primary practice address
3407 Shamrock Ct Gautier MS 39553-5337
Phone: (228) 497-0690
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X R901599 Mississippi

Profile Details

NPI number 1699227124
LBN Legal business name Jordan, Renaldo
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 1st, 2016
Last updated Nov 1st, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699227124 NPPES
Mississippi MEDICAID 00018214

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