Provider Demographics
NPI:1275608200
Name:GORDON, EILEEN KILBANE (PNP)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:KILBANE
Last Name:GORDON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MRS
Other - First Name:EILEEN
Other - Middle Name:KILBANE
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PNP
Mailing Address - Street 1:9000 MENTOR AVE
Mailing Address - Street 2:100
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060
Mailing Address - Country:US
Mailing Address - Phone:440-974-4470
Mailing Address - Fax:440-974-4173
Practice Address - Street 1:9000 MENTOR AVE
Practice Address - Street 2:100
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4496
Practice Address - Country:US
Practice Address - Phone:440-974-4470
Practice Address - Fax:440-974-4173
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNPO2449363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics