Individual
MS. THERESA JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3300
(704) 295-3468
Mailing address
6035 FAIRVIEW RD, CHARLOTTE, NC 28210-3256
(704) 295-3300
(704) 295-3468
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2218
NC
237600000X
Audiologist-Hearing Aid Fitter
667
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16271
BCBSNC
NC
01
—
30109414
SELECT HEALTH
SC
01
—
6335254
CIGNA
—
05
—
7413304
—
NC
01
—
879963
WELLCARE OF SC
SC
01
—
9890230
AENTA
—
01
—
P01044553
RAILROAD MEDICARE PTAN
NC
05
—
SAN010
—
SC
Enumeration date
03/27/2008
Last updated
03/16/2015
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