Provider Demographics
NPI:1912173865
Name:YANKE, GORDON CHARLES (LPN)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:CHARLES
Last Name:YANKE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 W SPARROW RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-8757
Mailing Address - Country:US
Mailing Address - Phone:937-324-1252
Mailing Address - Fax:
Practice Address - Street 1:1546 W SPARROW RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-8757
Practice Address - Country:US
Practice Address - Phone:937-324-1252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN116001164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse