Individual
ALISSA A GORDON
Active
Individual
ALISSA A GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN, DNP
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
Update your record
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