Healthcare Provider Details

I. General information

NPI: 1730779042
Provider Name (Legal Business Name): JORDAN MILLER MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S BALLENGER HWY
FLINT MI
48532-3638
US

IV. Provider business mailing address

401 S BALLENGER HWY
FLINT MI
48532-3638
US

V. Phone/Fax

Practice location:
  • Phone: 510-342-5700
  • Fax:
Mailing address:
  • Phone: 810-342-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704325786
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: