Healthcare Provider Details

I. General information

NPI: 1942050562
Provider Name (Legal Business Name): JORDAN CROWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 LIBERTY ST
CHESAPEAKE VA
23324-2637
US

IV. Provider business mailing address

667 KINGSBOROUGH SQ STE 101
CHESAPEAKE VA
23320-4999
US

V. Phone/Fax

Practice location:
  • Phone: 757-917-5716
  • Fax:
Mailing address:
  • Phone: 801-930-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024189496
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024189496
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: