Basic Information
Provider Information | |||||||||
NPI: | 1265927859 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JOURDAN | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: | K | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6626 E 75TH ST STE 500 | ||||||||
Address2: |   | ||||||||
City: | INDIANAPOLIS | ||||||||
State: | IN | ||||||||
PostalCode: | 462502890 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3176217520 | ||||||||
FaxNumber: | 3178061112 | ||||||||
Practice Location | |||||||||
Address1: | 1601 MEDICAL ARTS BLVD STE 100 | ||||||||
Address2: |   | ||||||||
City: | ANDERSON | ||||||||
State: | IN | ||||||||
PostalCode: | 460113459 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7652985700 | ||||||||
FaxNumber: | 7652984916 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/26/2018 | ||||||||
LastUpdateDate: | 09/15/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/15/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 28190454A | IN | N |   | Nursing Service Providers | Registered Nurse |   | 363LF0000X | 71008193A | IN | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.