Provider Demographics
NPI:1407226970
Name:GORDINIER, DEANNA RENEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:RENEE
Last Name:GORDINIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 GARDINER VIEW AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1877
Mailing Address - Country:US
Mailing Address - Phone:502-456-0494
Mailing Address - Fax:
Practice Address - Street 1:4200 GARDINER VIEW AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1877
Practice Address - Country:US
Practice Address - Phone:502-456-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily