Provider Demographics
NPI:1326563917
Name:GORDON, ALISSA A (APN, DNP)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:A
Last Name:GORDON
Suffix:
Gender:F
Credentials:APN, DNP
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:A
Other - Last Name:HUECHTEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, DNP
Mailing Address - Street 1:500 W RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52801-1014
Mailing Address - Country:US
Mailing Address - Phone:563-336-3000
Mailing Address - Fax:563-336-3125
Practice Address - Street 1:2750 11TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201
Practice Address - Country:US
Practice Address - Phone:563-336-3000
Practice Address - Fax:563-327-2102
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016237363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1598759292Medicaid
IA1326563917Medicaid
IA132380068OtherIOWA MEDICARE
ILF400408026OtherILLINIOS MEDICARE