Provider Demographics
NPI:1245783661
Name:GORDON, LADONNA J
Entity Type:Individual
Prefix:MS
First Name:LADONNA
Middle Name:J
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 STONEBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-8956
Mailing Address - Country:US
Mailing Address - Phone:970-471-5373
Mailing Address - Fax:
Practice Address - Street 1:126 STONEBRIDGE CT.
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462
Practice Address - Country:US
Practice Address - Phone:970-471-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other