Provider Demographics
NPI:1134554785
Name:GORDON, DIANA M (FNP)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:M
Last Name:GORDON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 HAMPTON HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4948
Mailing Address - Country:US
Mailing Address - Phone:757-867-6160
Mailing Address - Fax:
Practice Address - Street 1:3212 HAMPTON HWY
Practice Address - Street 2:SUITE B
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-4948
Practice Address - Country:US
Practice Address - Phone:757-867-6160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily