Healthcare Provider Details

I. General information

NPI: 1023175114
Provider Name (Legal Business Name): MELANIE LYNN JORDAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 INTERNATIONAL CIR
SAN JOSE CA
95119-1130
US

IV. Provider business mailing address

875 W MAIN AVE
MORGAN HILL CA
95037-4016
US

V. Phone/Fax

Practice location:
  • Phone: 408-362-4791
  • Fax:
Mailing address:
  • Phone: 408-782-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNMW1153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: