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General NPI Number Information
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NPI Number | 1861195562
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Entity Type | Individual
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Provider Name | JORDAN E LAIRD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 7704 MATAPEAKE BUSINESS DR STE 110
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City | BRANDYWINE
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State | MD
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Zip | 20613-3036
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Country | US
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Telephone | 301-242-5678
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Fax | 410-367-2354
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Provider Business Mailing Address
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Address Line | 5403 STREAM BANK LN
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City | GREENBELT
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State | MD
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Zip | 20770-4098
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Country | US
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Telephone | 813-973-9738
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN1048625
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R230002
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | N118073
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R230002
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License Number State | MD
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