MEDICARE: MS. JORDAN HAUSER M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1023552478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JORDAN HAUSER M.S.

Provider Business Mailing Address
First Line	:	4651 CHARLOTTE PARK DR
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-1956
Country	:	US
Telephone Number	:	704-936-5567
Fax Number	:

Provider Business Practice Location Address
First Line	:	4651 CHARLOTTE PARK DR
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-1956
Country	:	US
Telephone Number	:	704-936-5567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2016
Last Update Date	:	12/05/2016

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