Provider Demographics
NPI:1609420017
Name:GLOVER, JORDAN LENAE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LENAE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5726 TREESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-8745
Mailing Address - Country:US
Mailing Address - Phone:304-674-5844
Mailing Address - Fax:
Practice Address - Street 1:4353 E STATE ROUTE 73 STE 150
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-8829
Practice Address - Country:US
Practice Address - Phone:513-855-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024921363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner