Individual
TARA RAE GORDIJENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
210 ISAAC DR, BUNKER HILL, WV 25413-4267
(681) 273-9995
(681) 227-9995
Mailing address
210 ISAAC DR, BUNKER HILL, WV 25413-4267
(681) 273-9995
(681) 227-9995
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP55602
MD
Other
Enumeration date
07/31/2026
Last updated
07/31/2026
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