Provider Demographics
NPI:1659618049
Name:JORDAN, REBEKAH HANNAY
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:HANNAY
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:SUSANNE
Other - Last Name:HANNAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:5525 RESEARCH PARK DR FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:571-291-6131
Mailing Address - Fax:571-291-6135
Practice Address - Street 1:21170 ASHBY PONDS BLVD
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6128
Practice Address - Country:US
Practice Address - Phone:571-291-6131
Practice Address - Fax:571-291-6135
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily