Healthcare Provider Details

I. General information

NPI: 1659618049
Provider Name (Legal Business Name): REBEKAH HANNAY JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBEKAH SUSANNE HANNAY NP-C

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21170 ASHBY PONDS BLVD
ASHBURN VA
20147-6128
US

IV. Provider business mailing address

5525 RESEARCH PARK DR FL 4
BALTIMORE MD
21228-4873
US

V. Phone/Fax

Practice location:
  • Phone: 571-291-6131
  • Fax: 571-291-6135
Mailing address:
  • Phone: 571-291-6131
  • Fax: 571-291-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170557
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: