Provider Demographics
NPI:1699049684
Name:GORDON, ODELYN LORNA (RN)
Entity type:Individual
Prefix:MRS
First Name:ODELYN
Middle Name:LORNA
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 1:18403 N CONDUIT AVE
Mailing Address - Street 2:SPRINGFIELD GARDENS
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3233
Mailing Address - Country:US
Mailing Address - Phone:718-949-7357
Mailing Address - Fax:
Practice Address - Street 1:13255 RIDGEDALE ST
Practice Address - Street 2:SPRINGFIELD GARDENS
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-1500
Practice Address - Country:US
Practice Address - Phone:718-276-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22. 581964163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool