Provider Demographics
NPI:1639936909
Name:GORDON, NARDIA (CDP)
Entity Type:Individual
Prefix:
First Name:NARDIA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 ROUTE 28 STE 1
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-3448
Mailing Address - Country:US
Mailing Address - Phone:508-432-9600
Mailing Address - Fax:508-432-7111
Practice Address - Street 1:915 ROUTE 28 STE 1
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-3448
Practice Address - Country:US
Practice Address - Phone:508-432-9600
Practice Address - Fax:508-432-7111
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACNA31005376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide