Individual
ALISA JOY GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
13220 WOODWARD AVE, HIGHLAND PARK, MI 48203-3610
(313) 868-1946
(313) 852-1631
Mailing address
8907 RUTLAND ST, DETROIT, MI 48228-2072
(313) 933-4284
(313) 852-1631
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703056485
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740313238
CHRISTIAN GUIDANCE CENTER
MI
05
—
3022440
—
MI
Enumeration date
03/27/2007
Last updated
07/09/2007
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