Healthcare Provider Details

I. General information

NPI: 1275631210
Provider Name (Legal Business Name): JESSICA JORDAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 LIBBY TER
RICHMOND VA
23223-7908
US

IV. Provider business mailing address

2910 LIBBY TERRACE
RICHMOND VA
23223-2910
US

V. Phone/Fax

Practice location:
  • Phone: 804-649-2001
  • Fax: 804-344-3379
Mailing address:
  • Phone: 804-649-2001
  • Fax: 804-344-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024120283
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: