Provider Demographics
NPI:1912264342
Name:GORDON, NICOLE J (HHC, CT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:GORDON
Suffix:
Gender:F
Credentials:HHC, CT
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Other - Credentials:
Mailing Address - Street 1:1801 RAMBLING RIDGE LN
Mailing Address - Street 2:APT 302
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1229
Mailing Address - Country:US
Mailing Address - Phone:973-271-7415
Mailing Address - Fax:
Practice Address - Street 1:10440 SHAKER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1200
Practice Address - Country:US
Practice Address - Phone:973-271-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education