Individual
CHRISTHA GOURDET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
225 VILLAGE AVE, ELMONT, NY 11003-4239
(516) 354-6164
Mailing address
225 VILLAGE AVE, ELMONT, NY 11003-4239
(516) 354-6164
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
296780
NY
Other
Enumeration date
10/19/2009
Last updated
10/19/2009
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