Healthcare Provider Details

I. General information

NPI: 1477481026
Provider Name (Legal Business Name): NINA GOMEZ GORDON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NINA PEREZ GOMEZ LPN

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 WINYAH LN
VINEYARD HAVEN MA
02568-5852
US

IV. Provider business mailing address

132 WINYAH LN
VINEYARD HAVEN MA
02568-5852
US

V. Phone/Fax

Practice location:
  • Phone: 508-693-2052
  • Fax:
Mailing address:
  • Phone: 508-693-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN69589
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: