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Individual
PETA-GAYE GORDON
Active
Individual
PETA-GAYE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
700285
NY
164W00000X
Licensed Practical Nurse
2804431
NY
Other
Enumeration date
07/14/2015
Last updated
07/15/2015
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