Healthcare Provider Details

I. General information

NPI: 1245040799
Provider Name (Legal Business Name): GORDON HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 KENMORE AVE
DEERFIELD IL
60015-4745
US

IV. Provider business mailing address

PO BOX 1073
DEERFIELD IL
60015-6001
US

V. Phone/Fax

Practice location:
  • Phone: 847-650-7235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALYSSA DALE GORDON
Title or Position: PRESIDENT
Credential: DNP
Phone: 847-650-7235