Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN219067L | PA |
Y | 363LA2200X | Nurse Practitioner - Adult Health | UP003277C | PA |
NPI | 1023077526 |
---|---|
Provider Name | Ms. Barbara Jean Gordon |
First Address | Sayre, PA 18840-1625 |
Second Address | Towanda, PA 18848-8107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 12/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500001498 | RR MEDICARE PIN (01) | PA |
CC9269 | RR MEDICARE GROUP (01) | PA |
GU039833 | MEDICARE GROUP (01) | PA |
S18296 | (02) |