Provider Demographics
NPI:1124419684
Name:JORDAN, MICHELE RENEE (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENEE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N RAINBOW BLVD
Mailing Address - Street 2:STE. 203
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1082
Mailing Address - Country:US
Mailing Address - Phone:702-259-1228
Mailing Address - Fax:702-259-1252
Practice Address - Street 1:500 N RAINBOW BLVD
Practice Address - Street 2:STE. 203
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1082
Practice Address - Country:US
Practice Address - Phone:702-259-1228
Practice Address - Fax:702-259-1252
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily