Provider Demographics
NPI:1366524365
Name:JORDAN, MICHELL M (DNP)
Entity type:Individual
Prefix:
First Name:MICHELL
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 LOCKERMAN ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1048
Mailing Address - Country:US
Mailing Address - Phone:410-479-3075
Mailing Address - Fax:833-914-0407
Practice Address - Street 1:410 LOCKERMAN ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1048
Practice Address - Country:US
Practice Address - Phone:410-479-3075
Practice Address - Fax:833-914-0407
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197956363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
97602401OtherBCBS MD
0009541449OtherAETNA PPO
MD049008300Medicaid
8355618OtherAETNA HMO
68320014OtherBCBD FEDERAL
231148Y5ZMedicare PIN
MD231148YGZ9Medicare PIN