Provider Demographics
NPI:1609295138
Name:GORDON, LORNA (RN)
Entity Type:Individual
Prefix:MS
First Name:LORNA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 E 46TH ST
Mailing Address - Street 2:#E4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4248
Mailing Address - Country:US
Mailing Address - Phone:718-922-4873
Mailing Address - Fax:
Practice Address - Street 1:428 E 46TH ST
Practice Address - Street 2:#E4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4248
Practice Address - Country:US
Practice Address - Phone:718-922-4873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY654479-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse