Provider Demographics
NPI:1083832257
Name:GORDON, JANET L (MSNCPNP)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:L
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSNCPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 SILVERSIDE RD
Mailing Address - Street 2:1F QUILLEN BLDG
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4900
Mailing Address - Country:US
Mailing Address - Phone:302-478-2613
Mailing Address - Fax:302-478-2637
Practice Address - Street 1:3521 SILVERSIDE RD
Practice Address - Street 2:1F QUILLEN BLDG
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4900
Practice Address - Country:US
Practice Address - Phone:302-478-2613
Practice Address - Fax:302-478-2637
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELJ-0000160363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics