Doctor Name: | ELIZABETH GORDON |
NPI Number: | 1063817120 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 2014023979 |
Business Practice Address: | 4800 Mexico Rd Suite 102 Saint Peters, MO - 633761666 |
Business Phone Number: | 6364410067 |
Business Fax Number: | 6364411062 |
Mailing Address: | Po Box 23340, SAINT LOUIS |
State: | MO |
Postal Code: | 631563340 |
Phone Number: | 6364410067 |
Fax Number: | 6364411062 |
NPI Enumeration Date: | 10/30/2014 |
NPI Last Update Date: | 10/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2014023979 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |