Individual
HAILEY M GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
260 S TEN MILE RD, MERIDIAN, ID 83642-6100
(208) 809-2872
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
53504
ID
Other
Enumeration date
10/10/2019
Last updated
07/14/2021
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