Provider Demographics
NPI:1578086443
Name:GORDY, DONNA MARIE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:GORDY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 E CHAUNCEY LN STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-3114
Mailing Address - Country:US
Mailing Address - Phone:480-502-5533
Mailing Address - Fax:480-502-5761
Practice Address - Street 1:7010 E CHAUNCEY LN STE 145
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-3114
Practice Address - Country:US
Practice Address - Phone:480-502-5533
Practice Address - Fax:480-502-5761
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily