Individual
PHEBE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NPC
Contact information
Practice address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-8000
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
CNP 4837
MN
Other
Enumeration date
10/03/2016
Last updated
12/21/2016
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