Basic Information
| Provider Information | |||||||||
| NPI: | 1912277450 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JORDAN | ||||||||
| FirstName: | LEANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN773622 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 CLEVELAND AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954014298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075760818 | ||||||||
| FaxNumber: | 7075767845 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 CLEVELAND AVE STE B | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954014298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075760818 | ||||||||
| FaxNumber: | 7075767845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2011 | ||||||||
| LastUpdateDate: | 12/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA0400X | RN773622 | CA | Y | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) |
No ID Information.