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Individual

MICHELL M JORDAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DNP

Contact information

Practice address
410 LOCKERMAN ST, DENTON, MD 21629-1048
(410) 479-3075
(833) 914-0407
Mailing address
410 LOCKERMAN ST, DENTON, MD 21629-1048
(410) 479-3075
(833) 914-0407

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R197956
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0009541449
AETNA PPO
05
049008300
MD
01
68320014
BCBD FEDERAL
01
8355618
AETNA HMO
01
97602401
BCBS MD
Enumeration date
10/19/2006
Last updated
06/28/2023
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