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General NPI Number Information
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NPI Number | 1649344094
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Entity Type | Individual
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Provider Name | CAROLYN A JORDAN NP
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 236 HIGHLAND AVE
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City | SOMERVILLE
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State | MA
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Zip | 02143-1495
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Country | US
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Telephone | 617-591-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVE STE 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone | 617-414-5951
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Fax | 617-414-9201
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN256168
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | RN256168
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License Number State | MA
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