Provider Demographics
NPI:1437501582
Name:GORDON, COURTNEY (RN)
Entity Type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1327
Mailing Address - Country:US
Mailing Address - Phone:626-993-1212
Mailing Address - Fax:626-204-0086
Practice Address - Street 1:455 W MONTANA ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1327
Practice Address - Country:US
Practice Address - Phone:626-993-1212
Practice Address - Fax:626-204-0086
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA784465163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse