Provider Demographics
NPI:1811223209
Name:GORDILLO, NARDA GABRIELA (BS)
Entity Type:Individual
Prefix:MRS
First Name:NARDA
Middle Name:GABRIELA
Last Name:GORDILLO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 MAIN ST E
Mailing Address - Street 2:PO BOX 470
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2735
Mailing Address - Country:US
Mailing Address - Phone:715-231-2723
Mailing Address - Fax:715-232-5987
Practice Address - Street 1:808 MAIN ST E
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2735
Practice Address - Country:US
Practice Address - Phone:715-231-2723
Practice Address - Fax:715-232-5987
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist