Doctor Name: | MARY E GORDON |
NPI Number: | 1609863182 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | R016730 |
Business Practice Address: | 325e Kennedy Memorial Dr Waterville, ME - 049014531 |
Business Phone Number: | 2078735665 |
Business Fax Number: | 2078735545 |
Mailing Address: | 325e Kennedy Memorial Dr, WATERVILLE |
State: | ME |
Postal Code: | 049014531 |
Phone Number: | 2078735665 |
Fax Number: | 2078735545 |
NPI Enumeration Date: | 09/30/2005 |
NPI Last Update Date: | 11/28/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R016730 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |