Provider Demographics
NPI:1952068470
Name:GORDON, TIERRA ELLE
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:ELLE
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 1:25571 CHATWORTH DR
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1843
Mailing Address - Country:US
Mailing Address - Phone:216-925-2212
Mailing Address - Fax:
Practice Address - Street 1:25571 CHATWORTH DR
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1843
Practice Address - Country:US
Practice Address - Phone:216-925-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide