Individual
HEATHER GORDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
611 E DOUGLAS RD STE 200, MISHAWAKA, IN 46545-1465
(574) 335-6850
(574) 335-0849
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2059
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71012042A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102223470
ANTHEM
IN
05
—
300057950
—
IN
Enumeration date
10/12/2021
Last updated
11/09/2023
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