Healthcare Provider Details

I. General information

NPI: 1154093391
Provider Name (Legal Business Name): JORDAN LYNNE DEWHURST FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 OLD ROAD TO 9 ACRE COR STE 830
CONCORD MA
01742-4191
US

IV. Provider business mailing address

131 OLD ROAD TO 9 ACRE COR STE 830
CONCORD MA
01742-4191
US

V. Phone/Fax

Practice location:
  • Phone: 978-371-1396
  • Fax: 978-371-8277
Mailing address:
  • Phone: 978-371-1396
  • Fax: 978-371-8277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberRN2337117
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2337117
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2337117
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: