Healthcare Provider Details

I. General information

NPI: 1467235077
Provider Name (Legal Business Name): JORDAN LUNSFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 TRENT DR
DURHAM NC
27705-3904
US

IV. Provider business mailing address

307 TRENT DR
DURHAM NC
27710-3038
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-4248
  • Fax:
Mailing address:
  • Phone: 336-681-3081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number332722
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: