Provider Demographics
NPI:1558786848
Name:GORDON, DEANNA (DEM)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 E 1950 N
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3463
Mailing Address - Country:US
Mailing Address - Phone:801-836-5975
Mailing Address - Fax:
Practice Address - Street 1:1685 E 1950 N
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3463
Practice Address - Country:US
Practice Address - Phone:801-836-5975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife