Healthcare Provider Details

I. General information

NPI: 1871701995
Provider Name (Legal Business Name): ADRIANNA GORDON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 LANCASTER AVE
PAOLI PA
19301-1550
US

IV. Provider business mailing address

1776 LANCASTER AVE
PAOLI PA
19301-1550
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-4366
  • Fax:
Mailing address:
  • Phone: 610-647-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP008884
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: