Provider Demographics
NPI:1386283380
Name:GORDON, CHARLAYNE MARIE
Entity type:Individual
Prefix:
First Name:CHARLAYNE
Middle Name:MARIE
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 4TH ST SW APT 724
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-4490
Mailing Address - Country:US
Mailing Address - Phone:703-864-8946
Mailing Address - Fax:
Practice Address - Street 1:1150 4TH ST SW APT 724
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-4490
Practice Address - Country:US
Practice Address - Phone:202-827-3536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant