Provider Demographics
NPI:1033493291
Name:AVDICH, GORDANA (LPN)
Entity Type:Individual
Prefix:
First Name:GORDANA
Middle Name:
Last Name:AVDICH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 BIEBEL AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2806
Mailing Address - Country:US
Mailing Address - Phone:814-866-8096
Mailing Address - Fax:
Practice Address - Street 1:1626 BIEBEL AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2806
Practice Address - Country:US
Practice Address - Phone:814-866-8096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN281344164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse