Provider Demographics
NPI:1881311991
Name:DOEHNER, JORDAN BETH (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:BETH
Last Name:DOEHNER
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 EDGEMOOR RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3403
Mailing Address - Country:US
Mailing Address - Phone:443-540-8738
Mailing Address - Fax:
Practice Address - Street 1:828 DULANEY VALLEY RD
Practice Address - Street 2:STE 12
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2822
Practice Address - Country:US
Practice Address - Phone:410-343-9869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR230485363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health