Provider Demographics
NPI:1821618042
Name:IDE, JORDAN H (MSN, FNP-BC, ANCC)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:H
Last Name:IDE
Suffix:
Gender:F
Credentials:MSN, FNP-BC, ANCC
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:63 EMERALD ST
Mailing Address - Street 2:PMB 130
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-520-7431
Mailing Address - Fax:
Practice Address - Street 1:410 MIRACLE MILE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2639
Practice Address - Country:US
Practice Address - Phone:603-520-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134678363LF0000X
NH390200000X
NH071684-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH071684-23OtherSTATE OF NH BOARD OF NURSING
VT101.0134678OtherSTATE OF VT BOARD OF NURSING