Provider Demographics
NPI:1336893593
Name:JORDAN, JOANNALYN JOHNSON
Entity Type:Individual
Prefix:
First Name:JOANNALYN
Middle Name:JOHNSON
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 COLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1649
Mailing Address - Country:US
Mailing Address - Phone:434-238-4206
Mailing Address - Fax:
Practice Address - Street 1:6200 COLEBROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1649
Practice Address - Country:US
Practice Address - Phone:434-238-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula