Provider Demographics
NPI:1417298407
Name:GORDON, DONNA R
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:R
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 1:1104 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2759
Mailing Address - Country:US
Mailing Address - Phone:907-375-3200
Mailing Address - Fax:907-375-3292
Practice Address - Street 1:1104 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2759
Practice Address - Country:US
Practice Address - Phone:907-375-3200
Practice Address - Fax:907-375-3292
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator