Provider Demographics
NPI:1891526562
Name:GORDON, ELIZABETH J (AGACNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:GORDON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12550 SE 93RD AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6787
Mailing Address - Country:US
Mailing Address - Phone:503-654-1153
Mailing Address - Fax:503-654-7693
Practice Address - Street 1:12550 SE 93RD AVE STE 250
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6787
Practice Address - Country:US
Practice Address - Phone:503-654-1153
Practice Address - Fax:503-654-7693
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10029557363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care