Provider Demographics
NPI:1386399822
Name:GORDON, MARIAN KATHLEEN (CNP)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:KATHLEEN
Last Name:GORDON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4048 DRESSLER RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2784
Mailing Address - Country:US
Mailing Address - Phone:330-478-4132
Mailing Address - Fax:330-478-3341
Practice Address - Street 1:4048 DRESSLER RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2784
Practice Address - Country:US
Practice Address - Phone:330-478-4132
Practice Address - Fax:330-478-3341
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH024695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily