Individual
JESSICA LYNN GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
301 PROSPECT AVE, SYRACUSE, NY 13203-1807
(315) 299-5451
(315) 299-4710
Mailing address
8129 NAVONA LN, CLAY, NY 13041-8966
(315) 382-4521
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
590938-1
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
104815
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
590938-1
RN LISENSURE
NY
Enumeration date
10/08/2014
Last updated
08/06/2015
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