Provider Demographics
NPI:1518131598
Name:GORDON, MARTHA L (BSN IBCLC)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:GORDON
Suffix:
Gender:F
Credentials:BSN IBCLC
Other - Prefix:
Other - First Name:MARTY
Other - Middle Name:L
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN, IBCLC
Mailing Address - Street 1:1421 NW 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5340
Mailing Address - Country:US
Mailing Address - Phone:206-781-9871
Mailing Address - Fax:
Practice Address - Street 1:1421 NW 70TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-5340
Practice Address - Country:US
Practice Address - Phone:206-781-9871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN0059368163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse