MEDICARE: JORDAN MARIE MEARS NP

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	207Q00000X	Family Medicine Physician	0024186572	VA

General Provider Information

NPI Number	:	1437847811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN MARIE MEARS NP

Provider Business Mailing Address
First Line	:	4817 ALGONAC AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-2201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4817 ALGONAC AVE
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-2201
Country	:	US
Telephone Number	:	757-969-8845
Fax Number	:

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

Provider Enumeration Date	:	04/25/2023
Last Update Date	:	04/25/2023

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