Provider Demographics
NPI:1588856488
Name:JEFFERSON-GORDON, JUDITH (RN, BSN,MBA)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:JEFFERSON-GORDON
Suffix:
Gender:F
Credentials:RN, BSN,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3339 RETRIEVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7500
Mailing Address - Country:US
Mailing Address - Phone:614-833-4747
Mailing Address - Fax:
Practice Address - Street 1:3339 RETRIEVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7500
Practice Address - Country:US
Practice Address - Phone:614-833-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN214106163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse