Active NPI
Ivy Justine Jordan, L.P.N.
- Licensed Practical Nurse
- Canton, OH
National Provider Identifier
1336343318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN 106915
- Practice address
- 105 Wertz Ave NW Apt 7
Canton, OH 44708-4100 - Phone
- (330) 452-1539
- NPI assigned
- Jun 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN 106915 | OH | Primary |
Addresses
Primary practice location
105 Wertz Ave NW Apt 7
Canton, OH 44708-4100
Mailing address
105 Wertz Ave NW Apt 7
Canton, OH 44708-4100
Phone (330) 452-1539
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PN 106915 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294704000000",
"number": "1336343318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 WERTZ AVE NW APT 7",
"city": "CANTON",
"state": "OH",
"postal_code": "447084100",
"telephone_number": "330-452-1539"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 WERTZ AVE NW APT 7",
"city": "CANTON",
"state": "OH",
"postal_code": "447084100",
"telephone_number": "330-452-1539"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "IVY",
"middle_name": "JUSTINE",
"name_prefix": "Ms.",
"credential": "L.P.N.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-13",
"last_updated": "2011-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN 106915",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.