Provider Demographics
NPI:1588165724
Name:JORDAN, RACHEL ELAINE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:ELAINE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12116 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5728
Mailing Address - Country:US
Mailing Address - Phone:301-452-0657
Mailing Address - Fax:
Practice Address - Street 1:90 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-4303
Practice Address - Country:US
Practice Address - Phone:443-837-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1033171363LF0000X
MDR217895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily