Individual
KELLEY GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
321 FERRY ST, # 6, EVERETT, MA 02149-5608
(617) 785-4812
Mailing address
321 FERRY ST, # 6, EVERETT, MA 02149-5608
(617) 785-4812
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN69985
MA
Other
Enumeration date
11/10/2011
Last updated
11/10/2011
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