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NPI Code Detail

MEDICARE: JORDYN D NOULLET CRNP

MEDICARE: JORDYN D NOULLET CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LC0200XCritical Care Medicine Nurse PractitionerSP026133PA
2363L00000XNurse PractitionerSP026133PA

General Provider Information

NPI Number : 1013636265
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDYN D NOULLET CRNP
Provider Business Mailing Address
First Line : 100 N ACADEMY AVE
Second Line :
City : DANVILLE
State : PA
Zip : 17822-4903
Country : US
Telephone Number : 570-271-6144
Fax Number :
Provider Business Practice Location Address
First Line : 1800 MULBERRY ST
Second Line :
City : SCRANTON
State : PA
Zip : 18510-2369
Country : US
Telephone Number : 570-703-8231
Fax Number : 570-703-8250
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2022
Last Update Date : 11/27/2023

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