Provider Demographics
NPI:1093539074
Name:GORDON, EMILY A (NP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:GORDON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1235 OSOS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3619
Mailing Address - Country:US
Mailing Address - Phone:805-596-4517
Mailing Address - Fax:805-546-6038
Practice Address - Street 1:1235 OSOS ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3619
Practice Address - Country:US
Practice Address - Phone:805-596-4517
Practice Address - Fax:805-546-6038
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95032444363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics