Provider Demographics
NPI:1689001059
Name:JORDOW, RECHELE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:RECHELE
Middle Name:
Last Name:JORDOW
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-6335
Mailing Address - Country:US
Mailing Address - Phone:617-515-9804
Mailing Address - Fax:
Practice Address - Street 1:60 GRANITE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2915
Practice Address - Country:US
Practice Address - Phone:781-599-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202020363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health