Individual
EVADNEY DAWNMARIE GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
127 MAPLE LN, MEDFORD, NY 11763-1027
(631) 926-7557
Mailing address
127 MAPLE LN, MEDFORD, NY 11763-1027
Taxonomy
Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
305179-1
NY
Other
Enumeration date
10/28/2009
Last updated
10/28/2009
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