Healthcare Provider Details

I. General information

NPI: 1104737410
Provider Name (Legal Business Name): KRISTINA DANNELL GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S D ST
EDGAR NE
68935-3180
US

IV. Provider business mailing address

707 S D ST
EDGAR NE
68935-3180
US

V. Phone/Fax

Practice location:
  • Phone: 402-224-0210
  • Fax:
Mailing address:
  • Phone: 402-224-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: