Healthcare Provider Details

I. General information

NPI: 1215853288
Provider Name (Legal Business Name): MEGAN RONAE GORDON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 W BRISTOL RD STE 100
FLINT MI
48507-3154
US

IV. Provider business mailing address

161 W 1ST AVE
PLAINWELL MI
49080-1294
US

V. Phone/Fax

Practice location:
  • Phone: 810-620-8118
  • Fax:
Mailing address:
  • Phone: 269-532-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704449035
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: