Individual
AVA GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
704 KENILWORTH AVE, PHILADELPHIA, PA 19126-3715
(347) 249-2499
Mailing address
704 KENILWORTH AVE, PHILADELPHIA, PA 19126-3715
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN268026
PA
Other
Enumeration date
10/12/2023
Last updated
10/12/2023
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