Provider Demographics
NPI:1730466905
Name:GORDON, EVELYN
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 OGDEN ST
Mailing Address - Street 2:1761 OGDEN STREET
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1017
Mailing Address - Country:US
Mailing Address - Phone:303-863-9670
Mailing Address - Fax:303-863-8063
Practice Address - Street 1:1761 OGDEN ST
Practice Address - Street 2:1761 OGDEN STREET
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1017
Practice Address - Country:US
Practice Address - Phone:303-863-9670
Practice Address - Fax:303-863-8063
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist