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General NPI Number Information
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NPI Number | 1023838562
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Entity Type | Individual
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Provider Name | JORDAN MARIE HENRY PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 4248 HARBOR BEACH BLVD
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City | BRIGANTINE
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State | NJ
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Zip | 08203-1619
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Country | US
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Telephone | 609-266-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 14 BAYVIEW PL
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City | OCEAN CITY
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State | NJ
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Zip | 08226-2902
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Country | US
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Telephone | 856-472-8424
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00888300
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License Number State | NJ
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