Provider Demographics
NPI:1568036069
Name:WATTENBURGER, JORDAN REBECCA (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:REBECCA
Last Name:WATTENBURGER
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:REBECCA
Other - Last Name:TYSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:403 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2311
Mailing Address - Country:US
Mailing Address - Phone:919-650-9188
Mailing Address - Fax:
Practice Address - Street 1:403 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2399
Practice Address - Country:US
Practice Address - Phone:910-592-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014862363LF0000X
NC246720163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse