Individual
MIKAYLA VAN GORDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
510 S 4TH ST STE 600, FULTON, NY 13069-2952
(315) 598-4790
(315) 593-6195
Mailing address
61 DELANO ST, PULASKI, NY 13142-1400
(315) 298-6569
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
027732
NY
Other
Enumeration date
11/22/2021
Last updated
05/06/2024
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