Provider Demographics
NPI:1215732177
Name:GORDON, CRYSTAL (RN)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 GRAY LN
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:NC
Mailing Address - Zip Code:28438-0008
Mailing Address - Country:US
Mailing Address - Phone:910-640-7159
Mailing Address - Fax:
Practice Address - Street 1:95 GRAY LN
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:NC
Practice Address - Zip Code:28438-0008
Practice Address - Country:US
Practice Address - Phone:910-640-7159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC168047163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse