Individual
VICKI LEE GORDON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN NP
Contact information
Practice address
16001 W 9 MILE RD, DEPT OF SURGERY, SOUTHFIELD, MI 48075-4818
(248) 849-3000
Mailing address
25925 TELEGRAPH RD, 210, SOUTHFIELD, MI 48034-2518
(248) 746-0342
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
4704147901
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704147901
LICENSE
MI
Enumeration date
10/05/2005
Last updated
07/08/2007
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