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General NPI Number Information
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NPI Number | 1780280511
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Entity Type | Individual
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Provider Name | MICHELLE EILEEN JORDAN APRN
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Gender | Female
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 1S450 SUMMIT AVE
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-3990
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Country | US
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Telephone | 630-376-6559
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Fax |
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Provider Business Mailing Address
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Address Line | 1S450 SUMMIT AVE
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City | OAKBROOK TERRACE
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State | IL
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Zip | 60181-3990
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Country | US
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Telephone | 630-376-6559
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 209021573
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License Number State | IL
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