Provider Demographics
NPI:1679800643
Name:JORDAN, CHARLENE MICHELE (FNP-BC, RN)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MICHELE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:FNP-BC, RN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2013 JEFFERSON ST SW
Mailing Address - Street 2:FL 2
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2419
Mailing Address - Country:US
Mailing Address - Phone:540-982-0237
Mailing Address - Fax:540-982-2719
Practice Address - Street 1:2955 MARKET ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6575
Practice Address - Country:US
Practice Address - Phone:540-381-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily