Provider Demographics
NPI:1932813730
Name:GORDON, YVONNE MARILEE
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MARILEE
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 1:85 GOFF RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-9551
Mailing Address - Country:US
Mailing Address - Phone:814-631-3470
Mailing Address - Fax:
Practice Address - Street 1:4457 SUMMERSVILLE LAKE RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-5097
Practice Address - Country:US
Practice Address - Phone:814-631-3470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker