Individual
TIFFANY M GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4665 E SUNSET DR, SYRACUSE, IN 46567-9168
(866) 627-8233
(877) 710-7891
Mailing address
813 N MAIN ST, AVILLA, IN 46710-9658
(260) 318-2903
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
0500869
IN
Other
Enumeration date
11/30/2009
Last updated
11/30/2009
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