Healthcare Provider Details

I. General information

NPI: 1851062939
Provider Name (Legal Business Name): JORDAN CHAUNCEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 JACKSON ST
DENVER CO
80206-2762
US

IV. Provider business mailing address

1001 E BAYAUD AVE APT 407
DENVER CO
80209-2374
US

V. Phone/Fax

Practice location:
  • Phone: 303-650-4042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number348546
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: