Provider Demographics
NPI:1689813859
Name:GORDON, LYNNE ALISON (LM)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:ALISON
Last Name:GORDON
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 S LINDSAY RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-1503
Mailing Address - Country:US
Mailing Address - Phone:480-664-7463
Mailing Address - Fax:480-664-7467
Practice Address - Street 1:3303 S LINDSAY RD
Practice Address - Street 2:SUITE 125
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1503
Practice Address - Country:US
Practice Address - Phone:480-664-7463
Practice Address - Fax:480-664-7467
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLM158176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife