Healthcare Provider Details

I. General information

NPI: 1972049609
Provider Name (Legal Business Name): KAREN LEE GORDON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 04/18/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S WASHINGTON ST STE 12
GETTYSBURG PA
17325-2516
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-339-2875
  • Fax: 717-334-3921
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-273-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberSP016859
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP016859
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: