Provider Demographics
NPI:1528781804
Name:MAXWELL, JORDAN REBEKAH (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:REBEKAH
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:REBEKAH
Other - Last Name:EARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE, MAIDEN NAME
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 N SAMUEL MOORE PKWY
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1467
Practice Address - Country:US
Practice Address - Phone:317-483-5000
Practice Address - Fax:317-483-5050
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF06221620363LF0000X
IN71013261A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily