Provider Demographics
NPI:1306099403
Name:GORDON, ROXANN M (RN, CNM)
Entity type:Individual
Prefix:MS
First Name:ROXANN
Middle Name:M
Last Name:GORDON
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13615 VOLAND CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MD
Mailing Address - Zip Code:21036
Mailing Address - Country:US
Mailing Address - Phone:443-621-5569
Mailing Address - Fax:240-708-4932
Practice Address - Street 1:13615 VOLAND CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MD
Practice Address - Zip Code:21036
Practice Address - Country:US
Practice Address - Phone:443-621-5569
Practice Address - Fax:240-708-4932
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR147748367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife