=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770365272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONSTANCE W JORDAN ANP PMHNP PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2023
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 962 SHORE RD
-----------------------------------------------------
City | CAPE ELIZABETH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04107-1516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-747-5958
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 305 COMMERCIAL ST STE 103
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04101-5625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-747-5958
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING AGENT
-----------------------------------------------------
Name | CHERYL MCATEE-THORNTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-452-4420
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------