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NPI Code Detail

MEDICARE: CHARLOTTE ELIZABETH JORDAN

MEDICARE: CHARLOTTE ELIZABETH JORDAN
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
1363LF0000XFamily Nurse PractitionerAP61151908WA

General Provider Information

NPI Number : 1730763400
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLOTTE ELIZABETH JORDAN
Provider Business Mailing Address
First Line : 4764 S GOLF COURSE DR
Second Line :
City : BLAINE
State : WA
Zip : 98230-6816
Country : US
Telephone Number : 360-441-3892
Fax Number :
Provider Business Practice Location Address
First Line : 4686 POINTES DR STE 219
Second Line :
City : MUKILTEO
State : WA
Zip : 98275-6038
Country : US
Telephone Number : 425-405-8089
Fax Number : 425-426-2277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2021
Last Update Date : 08/15/2022

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Directions to “ CHARLOTTE ELIZABETH JORDAN ” Practice Location

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