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NPI Code Detail

MEDICARE: MELVA JEANNE GORDON NURSE PRACTITIONER

MEDICARE: MELVA JEANNE GORDON NURSE PRACTITIONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN.254002-COA1OH
2163W00000XRegistered NurseARNP 9400274FL
3208D00000XGeneral Practice PhysicianAPRN9400274FL
4363LF0000XFamily Nurse Practitioner9400274FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750774725
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELVA JEANNE GORDON NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 818 BRITTANY DRIVE
Second Line : APT D
City : INDIALANTIC
State : FL
Zip : 32903-9477
Country : US
Telephone Number : 740-357-1505
Fax Number :
Provider Business Practice Location Address
First Line : 2159 DOGWOOD RIDGE RD
Second Line :
City : WHEELERSBURG
State : OH
Zip : 45694-9044
Country : US
Telephone Number : 740-574-2558
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2015
Last Update Date : 11/28/2021

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