Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99277 | TX |
NPI | 1154870152 |
---|---|
Provider Name | Cheryl Lynne Gordon |
First Address | Mabank, TX 75156-7155 |
Second Address | Mabank, TX 75156-7155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2016 |
Last Update Date | 02/10/2016 |