Provider Demographics
NPI:1639595309
Name:JORDAN, LENISE MARLENA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:LENISE
Middle Name:MARLENA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6085 OLD NATIONAL HWY STE G
Mailing Address - Street 2:
Mailing Address - City:SOUTH FULTON
Mailing Address - State:GA
Mailing Address - Zip Code:30349-4333
Mailing Address - Country:US
Mailing Address - Phone:844-644-4325
Mailing Address - Fax:855-583-3678
Practice Address - Street 1:6085 OLD NATIONAL HWY STE G
Practice Address - Street 2:
Practice Address - City:SOUTH FULTON
Practice Address - State:GA
Practice Address - Zip Code:30349-4333
Practice Address - Country:US
Practice Address - Phone:844-644-4325
Practice Address - Fax:855-583-3678
Is Sole Proprietor?:No
Enumeration Date:2014-03-05
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN162420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily