Provider Demographics
NPI:1942467253
Name:JORDAN, CHARLOTTE JOANNE (MSN RN CRNP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:JOANNE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MSN RN CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08014-0067
Mailing Address - Country:US
Mailing Address - Phone:856-467-8550
Mailing Address - Fax:
Practice Address - Street 1:204 GROVE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08086-2557
Practice Address - Country:US
Practice Address - Phone:856-467-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07483600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health