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Individual

ALISSA A GORDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APN, DNP

Contact information

Practice address
2750 11TH ST, ROCK ISLAND, IL 61201
(563) 336-3000
(563) 327-2102
Mailing address
500 W RIVER DR, DAVENPORT, IA 52801-1014
(563) 336-3000
(563) 336-3125

Taxonomy

Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
209016237
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
132380068
IOWA MEDICARE
IA
05
1326563917
IA
05
1598759292
IL
01
F400408026
ILLINIOS MEDICARE
IL
Enumeration date
08/04/2017
Last updated
07/27/2018
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