Individual
CHANELLE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
11816 197TH ST, SAINT ALBANS, NY 11412-3456
(347) 752-8240
Mailing address
11816 197TH ST, SAINT ALBANS, NY 11412-3456
(347) 752-8240
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
354879
NY
Other
Enumeration date
12/27/2016
Last updated
09/07/2024
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