Individual
DR. LISA MICHELLE GORDON-GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN- BC
Contact information
Practice address
950 CAMPBELL AVE, WEST HAVEN, CT 06516-2770
(203) 932-5711
Mailing address
168 COLUMBIA BLVD, WATERBURY, CT 06710-1707
(914) 447-5580
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
503718
NY
163W00000X
Registered Nurse
79074
CT
363LF0000X
Family Nurse Practitioner
Primary
12.009813
CT
363LF0000X
Family Nurse Practitioner
349633
NY
Other
Enumeration date
07/27/2020
Last updated
12/27/2023
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