Individual
DEIDRE ALLISON GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5905 CARPENTER RD, APT 1, ZACHARY, LA 70791-4061
(225) 301-6616
Mailing address
5905 CARPENTER RD, APT 1, ZACHARY, LA 70791-4061
(225) 301-6616
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20100280
LA
Other
Enumeration date
07/20/2015
Last updated
07/20/2015
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