Provider Demographics
NPI:1598840324
Name:GORDON, TERESA BETH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:BETH
Last Name:GORDON
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:100 MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9762
Mailing Address - Country:US
Mailing Address - Phone:412-359-6581
Mailing Address - Fax:412-359-3483
Practice Address - Street 1:100 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-9762
Practice Address - Country:US
Practice Address - Phone:412-359-6581
Practice Address - Fax:412-359-3483
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN293619L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered