Provider Demographics
NPI:1972290138
Name:CHADWICK, JORDANA LOUISE
Entity type:Individual
Prefix:MRS
First Name:JORDANA
Middle Name:LOUISE
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5901
Mailing Address - Country:US
Mailing Address - Phone:910-616-8278
Mailing Address - Fax:
Practice Address - Street 1:913 S 11TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5901
Practice Address - Country:US
Practice Address - Phone:910-616-8278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20946374172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver