Healthcare Provider Details

I. General information

NPI: 1881384212
Provider Name (Legal Business Name): JORDAN SEWARD MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 JERRYANNE CT
APEX NC
27523-3815
US

IV. Provider business mailing address

201 JERRYANNE CT
APEX NC
27523-3815
US

V. Phone/Fax

Practice location:
  • Phone: 919-924-2372
  • Fax:
Mailing address:
  • Phone: 919-924-2372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL007509
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: