Provider Demographics
NPI:1639870918
Name:GORDON, JAMIE (WHNP)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1380
Mailing Address - Country:US
Mailing Address - Phone:443-493-7575
Mailing Address - Fax:443-493-7575
Practice Address - Street 1:506 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1380
Practice Address - Country:US
Practice Address - Phone:410-924-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELH-0010272207V00000X
MDR230295363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology