Provider Demographics
NPI:1578781951
Name:GORDON, SARA NAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:NAN
Last Name:GORDON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:NAN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:1212 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2602
Mailing Address - Country:US
Mailing Address - Phone:319-558-3844
Mailing Address - Fax:319-364-2716
Practice Address - Street 1:1212 7TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2602
Practice Address - Country:US
Practice Address - Phone:319-558-3844
Practice Address - Fax:319-364-2716
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100940363L00000X
IAC100940363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner