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General NPI Number Information
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NPI Number | 1033328752
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Entity Type | Individual
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Provider Name | NANCY LYNN GORDON-GREEN R.N., M.A.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 483 MIDDLE TPKE W SUITE #205
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City | MANCHESTER
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State | CT
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Zip | 06040-3863
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Country | US
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Telephone | 860-646-3382
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Fax | 860-632-0622
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Provider Business Mailing Address
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Address Line | 483 MIDDLE TPKE W SUITE #205
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City | MANCHESTER
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State | CT
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Zip | 06040-3863
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Country | US
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Telephone | 860-646-3382
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Fax | 860-632-0622
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | E54252
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License Number State | CT
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