Provider Demographics
NPI:1215161526
Name:BLACK, GORDON C (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:C
Last Name:BLACK
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743
Mailing Address - Country:US
Mailing Address - Phone:603-543-6940
Mailing Address - Fax:603-543-6950
Practice Address - Street 1:5 DUNNING ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743
Practice Address - Country:US
Practice Address - Phone:603-543-1251
Practice Address - Fax:603-542-3558
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH037311-23363LF0000X
VT101.0053103363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily