Healthcare Provider Details

I. General information

NPI: 1033079926
Provider Name (Legal Business Name): JORDAN LAWSON DNP, RN, CNL, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E BROAD ST
RICHMOND VA
23219-1930
US

IV. Provider business mailing address

1528 CRIMSON LEAF LN
WAKE FOREST NC
27587-3379
US

V. Phone/Fax

Practice location:
  • Phone: 804-519-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number301902
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: