Individual
MRS. ELLEN M GORDON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1523 WAKE AVE, RIVERSIDE, OH 45431-1235
(937) 623-9143
(937) 253-5419
Mailing address
1523 WAKE AVE, RIVERSIDE, OH 45431-1235
(937) 623-9143
(937) 253-5419
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN095501
OH
Other
Enumeration date
03/07/2006
Last updated
07/08/2007
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