Provider Demographics
NPI:1942650171
Name:GORDON, MELISSA PATRICE (LVN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:PATRICE
Last Name:GORDON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6242 MULAN ST
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-0790
Mailing Address - Country:US
Mailing Address - Phone:860-997-1747
Mailing Address - Fax:
Practice Address - Street 1:2822 MONROE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4284
Practice Address - Country:US
Practice Address - Phone:860-997-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-19
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273053164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse