Provider Demographics
NPI:1508455460
Name:MOOREFIELD, JORDAN A (MSN, RN)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:A
Last Name:MOOREFIELD
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 CAMPVIEW RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-7620
Mailing Address - Country:US
Mailing Address - Phone:434-203-7365
Mailing Address - Fax:
Practice Address - Street 1:1176 CAMPVIEW RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-7620
Practice Address - Country:US
Practice Address - Phone:434-203-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001297877163W00000X
PARN737555163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse