Provider Demographics
NPI:1295590255
Name:GORDON, LETEYONA
Entity type:Individual
Prefix:
First Name:LETEYONA
Middle Name:
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 1:5206 EASTER LN APT 3F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-3472
Mailing Address - Country:US
Mailing Address - Phone:330-338-7930
Mailing Address - Fax:
Practice Address - Street 1:5206 EASTER LN APT 3F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-3472
Practice Address - Country:US
Practice Address - Phone:330-338-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.492377163W00000X
NC350893163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse