Individual
ANDREA ALEXIS GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
6308 8TH AVENUE, STE 202, KENOSHA, WI 53143
(262) 653-5330
(262) 653-5346
Mailing address
6308 8TH AVENUE, STE 202, KENOSHA, WI 53143-5031
(262) 653-5330
(262) 653-5346
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
178314-030
WI
363L00000X
Nurse Practitioner
Primary
8432-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306377023
—
WI
01
—
8432-33
WI LICENSE
WI
Enumeration date
03/23/2017
Last updated
07/04/2018
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