Provider Demographics
NPI:1659197911
Name:LINDAMOOD, JORDAN ASHLEY
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ASHLEY
Last Name:LINDAMOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 N TAYLOR ST APT 509
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-4794
Mailing Address - Country:US
Mailing Address - Phone:904-993-5542
Mailing Address - Fax:
Practice Address - Street 1:102 IRVING ST NW FL 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2921
Practice Address - Country:US
Practice Address - Phone:410-823-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program