Doctor Name: | MRS. DIANA M GORDON |
NPI Number: | 1134554785 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 0024170894 |
Business Practice Address: | 3212 Hampton Hwy Suite B Yorktown, VA - 236934948 |
Business Phone Number: | 7578676160 |
Business Fax Number: | |
Mailing Address: | 3212 Hampton Hwy, Suite B YORKTOWN |
State: | VA |
Postal Code: | 236934948 |
Phone Number: | 7578676160 |
Fax Number: | |
NPI Enumeration Date: | 09/13/2013 |
NPI Last Update Date: | 02/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0024170894 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |