Provider Demographics
NPI:1740901123
Name:JORDAN, NATALIE LOUISE (APRN,CNP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:LOUISE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:APRN,CNP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:LOUISE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1509 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7618
Mailing Address - Country:US
Mailing Address - Phone:309-826-9334
Mailing Address - Fax:
Practice Address - Street 1:1765 BRADFORD LN
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-1296
Practice Address - Country:US
Practice Address - Phone:309-661-2400
Practice Address - Fax:309-661-6226
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily