Provider Demographics
NPI:1255021127
Name:GORDER, BREIANNA MARIE
Entity type:Individual
Prefix:
First Name:BREIANNA
Middle Name:MARIE
Last Name:GORDER
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 1:621 S ADAMS ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3259
Mailing Address - Country:US
Mailing Address - Phone:206-866-4213
Mailing Address - Fax:
Practice Address - Street 1:621 S ADAMS ST APT 6
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3259
Practice Address - Country:US
Practice Address - Phone:206-866-4213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist