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NPI Code Detail

MEDICARE: ANTWANETTE A GORDON

MEDICARE:   ANTWANETTE A GORDON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1205788072
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTWANETTE A GORDON
Provider Business Mailing Address
First Line : 1861 KENDALL ST NE APT 2
Second Line :
City : WASHINGTON
State : DC
Zip : 20002-1652
Country : US
Telephone Number : 202-531-4336
Fax Number :
Provider Business Practice Location Address
First Line : 1861 KENDALL ST NE APT 2
Second Line :
City : WASHINGTON
State : DC
Zip : 20002-1652
Country : US
Telephone Number : 202-531-4336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2026
Last Update Date : 02/12/2026

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Directions to “ ANTWANETTE A GORDON ” Practice Location

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