Peta-gaye Tisha Gordon

NPI 1053645341 - Licensed Practical Nurse - 164W00000X

NPI Details
NPI 1053645341
Gender Female
Enumeration Date 09/20/2009
Last Updated 09/20/2009
Entity Type Individual
Active Over 7 years ago
Practice Location
127 MAPLE LN
MEDFORD NY, 11763-1027, US
Phone (631) 576-5833
Fax
Business Location
127 MAPLE LN
MEDFORD NY, 11763-1027, US
Phone (631) 576-5833
Fax
Toxanomy
Taxonomy Code 164W00000X
License State New York
License Number 279643-1
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According to our database, Ms. Peta-gaye Tisha Gordon NPI is 1053645341, taxonomy code is 164W00000X and license number is 279643-1, license state is located at New York. Peta-gaye Tisha Gordon physically located at 127 Maple Ln, Medford NY, 11763-1027. NPI Number Peta-gaye Tisha Gordon has the Individual type.

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1053645341 NPI number is provided on an as is basis without warranty of any kind. 1053645341 is maintained by the National Plan & Provider Enumeration System. The contents of Peta-gaye Tisha Gordon are for informational purposes only.