Provider Demographics
NPI:1780981183
Name:GORDON, EARLINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:EARLINE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WYNDOVER WOODS LN
Mailing Address - Street 2:APT. 14
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3143
Mailing Address - Country:US
Mailing Address - Phone:914-684-0554
Mailing Address - Fax:
Practice Address - Street 1:3 WYNDOVER WOODS LN
Practice Address - Street 2:APT. 14
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3143
Practice Address - Country:US
Practice Address - Phone:914-684-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303287-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse