Provider Demographics
NPI:1659601680
Name:GORDON, DEBORAH SUZANNE (RN)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:SUZANNE
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 1:2930 ARBOR DRIVE
Mailing Address - Street 2:APT A
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1865
Mailing Address - Country:US
Mailing Address - Phone:608-628-6755
Mailing Address - Fax:
Practice Address - Street 1:2930 ARBOR DRIVE
Practice Address - Street 2:APT A
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1865
Practice Address - Country:US
Practice Address - Phone:608-628-6755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI119022-030(RN)163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health