Provider Demographics
NPI:1619544558
Name:GORDON, LETITIA (RN, LEC, DOULA)
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:RN, LEC, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3198 PARKWOOD BLVD APT 11084
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-9518
Mailing Address - Country:US
Mailing Address - Phone:469-767-8134
Mailing Address - Fax:
Practice Address - Street 1:107 MURRAY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1645
Practice Address - Country:US
Practice Address - Phone:469-608-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula