Individual
SHAVONNE L. GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
648 LATIOLAIS RD, BREAUX BRIDGE, LA 70517-4231
(337) 332-4878
(337) 332-4866
Mailing address
2308 COTEAU RD, NEW IBERIA, LA 70560-9172
(337) 339-0858
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
210430
LA
Other
Enumeration date
04/18/2023
Last updated
04/18/2023
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