Healthcare Provider Details

I. General information

NPI: 1427077163
Provider Name (Legal Business Name): DALE J GORDON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ACADEMY ST
PRESQUE ISLE ME
04769-3102
US

IV. Provider business mailing address

PO BOX 151
PRESQUE ISLE ME
04769-3102
US

V. Phone/Fax

Practice location:
  • Phone: 207-768-4000
  • Fax: 207-768-4046
Mailing address:
  • Phone: 207-768-4100
  • Fax: 207-768-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP081254
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: