Mary-Angela Jordan, DTR

Primary specialty

Registered Dietetic TechnicianTaxonomy code 136A00000X

Practice address

12112 W Tether TRL
Peoria, AZ 85383-5872

Phone

(480) 267-8767

NPI assigned

Nov 27, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Angela Jordan Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1701043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701561600000",
    "number": "1023884525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12112 W TETHER TRL",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853835872",
            "telephone_number": "480-267-8767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12112 W TETHER TRL",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853835872",
            "telephone_number": "480-267-8767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "MARY-ANGELA",
        "credential": "DTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-11-27",
        "last_updated": "2023-12-03",
        "certification_date": "2023-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "136A00000X",
            "taxonomy_group": "",
            "desc": "Dietetic Technician, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "JORDAN",
            "credential": "DTR",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Matthew Thomas Jones, DNP FNP-C
• Michelle Lenore Jones, RBT
• Natasha Jones
• Shelby Jones
• Jordan J Glenn PLLC
• Ronald K Jorgensen, MD
• Joseph a Caplan MD PC
• Willio Joseph, PA
• Joshi Integrated Clinic LLC
• Joshua S. Hong, DDS, PLLC

• Registered Dietetic Technician in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Registered Dietetic Technician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.