Individual
KELLEY LACEY GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1965 BIRKMONT DR, RANCHO CORDOVA, CA 95742-6407
(916) 294-9120
Mailing address
2139 HUNTINGTON CIR, EL DORADO HILLS, CA 95762-5825
(916) 508-5186
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
670085
CA
Other
Enumeration date
04/28/2025
Last updated
04/28/2025
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