MEDICARE: MISS RENA FLORENCE GORDON RN

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
1	163WH0200X	Home Health Registered Nurse	303414	OH

General Provider Information

NPI Number	:	1841325073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RENA FLORENCE GORDON RN

Provider Business Mailing Address
First Line	:	13775 SHAWNEE TRL
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-5525
Country	:	US
Telephone Number	:	440-289-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	13775 SHAWNEE TRL
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-5525
Country	:	US
Telephone Number	:	440-289-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	04/01/2016

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