Provider Demographics
NPI:1558965715
Name:GORDON, LEANNA (RN)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:
Other - Last Name:REHFELDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:143 COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2057
Mailing Address - Country:US
Mailing Address - Phone:907-903-9554
Mailing Address - Fax:
Practice Address - Street 1:143 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2057
Practice Address - Country:US
Practice Address - Phone:907-903-9554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN590642163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics