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General NPI Number Information
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NPI Number | 1245748748
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Entity Type | Individual
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Provider Name | AMY GORDON
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Gender | Female
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 1926 N 3RD ST STE 100
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City | FLAGSTAFF
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State | AZ
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Zip | 86004-4332
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Country | US
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Telephone | 928-856-0656
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 5TH AVE APT 14
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City | NEW YORK
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State | NY
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Zip | 10128-0102
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Country | US
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Telephone | 505-603-7790
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1118
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License Number State | AZ
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