Provider Demographics
NPI:1164185187
Name:GORDON, LEE-ANN (RN, MSN)
Entity Type:Individual
Prefix:
First Name:LEE-ANN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 MIDDLE PARK DR
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2243
Mailing Address - Country:US
Mailing Address - Phone:267-875-3295
Mailing Address - Fax:
Practice Address - Street 1:269 MIDDLE PARK DR
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2243
Practice Address - Country:US
Practice Address - Phone:267-875-3295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN500665-L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty