Provider Demographics
NPI:1104410885
Name:GORDON, IRINA (RN MSN CWOCN FNP-C)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:RN MSN CWOCN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 OAKMONT CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1235
Mailing Address - Country:US
Mailing Address - Phone:415-867-1815
Mailing Address - Fax:
Practice Address - Street 1:1728 DIVISADERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3012
Practice Address - Country:US
Practice Address - Phone:415-287-0859
Practice Address - Fax:415-599-8456
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95036640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily