Individual
LISA GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3646 MOUNT ELLIOTT ST, DETROIT, MI 48207-2311
(313) 626-2400
Mailing address
15212 SALEM CT, REDFORD, MI 48239-3441
(248) 325-7435
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704351548
MI
Other
Enumeration date
01/11/2025
Last updated
03/11/2025
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