Provider Demographics
NPI:1033328752
Name:GORDON-GREEN, NANCY LYNN (RN, MA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:GORDON-GREEN
Suffix:
Gender:F
Credentials:RN, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 MIDDLE TPKE W
Mailing Address - Street 2:SUITE #205
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-3863
Mailing Address - Country:US
Mailing Address - Phone:860-646-3382
Mailing Address - Fax:860-632-0622
Practice Address - Street 1:483 MIDDLE TPKE W
Practice Address - Street 2:SUITE #205
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3863
Practice Address - Country:US
Practice Address - Phone:860-646-3382
Practice Address - Fax:860-632-0622
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE54252163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult