Provider Demographics
NPI:1568718922
Name:GORDON, LYNN MARIE (RN, BSN, CNP)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:MARIE
Last Name:GORDON
Suffix:
Gender:F
Credentials:RN, BSN, CNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:BREMKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24324 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44090-9496
Mailing Address - Country:US
Mailing Address - Phone:440-669-3410
Mailing Address - Fax:
Practice Address - Street 1:3288 OBERLIN AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2752
Practice Address - Country:US
Practice Address - Phone:440-282-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13620-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily