Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 0024176330 | VA |
NPI | 1023502937 |
---|---|
Provider Name | Jessica Ann Jordan |
First Address | Chesapeake, VA 23320-3321 |
Second Address | Chesapeake, VA 23320-3871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2018 |
Last Update Date | 08/06/2021 |