Provider Information for 1609592997
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NYCOLE SHERICE JORDAN ALC
Sex: Female
NPI: 1609592997
Last Updated: 2022-10-18
Certification Date: 2022-10-18
Certification Date: 2022-10-18
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1609592997 | ||||||||
| Enumeration Date | 2022-10-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 9031 MOBILE, AL 36691-0031 United States Phone: 251-321-2013 | Fax: | ||||||||
| Primary Practice Address | 600 BEL AIR BLVD STE 128 MOBILE, AL 36606-3501 United States Phone: 251-321-2013 | Fax: | ||||||||
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