Provider Demographics
NPI:1285866681
Name:GORDON, ANNE MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:GORDON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CHERRYVALE
Mailing Address - State:KS
Mailing Address - Zip Code:67335-1729
Mailing Address - Country:US
Mailing Address - Phone:620-336-3255
Mailing Address - Fax:620-336-3755
Practice Address - Street 1:116 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:CHERRYVALE
Practice Address - State:KS
Practice Address - Zip Code:67335-1729
Practice Address - Country:US
Practice Address - Phone:620-336-3255
Practice Address - Fax:620-336-3755
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTMP139487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily