MEDICARE: SHAKEEMA JORDAN

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
1	363LF0000X	Family Nurse Practitioner	1518580034	NC
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518580034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAKEEMA JORDAN

Provider Business Mailing Address
First Line	:	600 MOYE BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-4300
Country	:	US
Telephone Number	:	252-744-6478
Fax Number	:

Provider Business Practice Location Address
First Line	:	7740 WOODLAND DRIVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278
Country	:	US
Telephone Number	:	260-467-9358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2020
Last Update Date	:	04/19/2024

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Directions to “ SHAKEEMA JORDAN ” Practice Location

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