MEDICARE: JORDAN CROWELL

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	363LG0600X	Gerontology Nurse Practitioner	0024189496	VA
2	363L00000X	Nurse Practitioner	0024189496	VA

General Provider Information

NPI Number	:	1942050562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN CROWELL

Provider Business Mailing Address
First Line	:	667 KINGSBOROUGH SQ STE 101
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4999
Country	:	US
Telephone Number	:	801-930-4362
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 LIBERTY ST
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-2637
Country	:	US
Telephone Number	:	757-917-5716
Fax Number	:

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

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	01/29/2025

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Directions to “ JORDAN CROWELL ” Practice Location

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