Provider Demographics
NPI:1437591146
Name:JORDAN, REBECCA L (CRNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:LINN
Other - Last Name:TYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:141 MEDICAL PARK LN
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823-9112
Mailing Address - Country:US
Mailing Address - Phone:814-355-7322
Mailing Address - Fax:814-355-9604
Practice Address - Street 1:141 MEDICAL PARK LN
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-9112
Practice Address - Country:US
Practice Address - Phone:814-355-7322
Practice Address - Fax:814-355-9604
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013682363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner