Healthcare Provider Details

I. General information

NPI: 1396433801
Provider Name (Legal Business Name): ABIGAIL GRACE JORDAN CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E CARVER ST
DURHAM NC
27704-2133
US

IV. Provider business mailing address

6710 CRESCENT MOON CT
RALEIGH NC
27606-5437
US

V. Phone/Fax

Practice location:
  • Phone: 919-471-2273
  • Fax:
Mailing address:
  • Phone: 252-337-4750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number12949961-3102
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: