Provider Demographics
NPI:1972318327
Name:GORDON, LAQUANDA
Entity type:Individual
Prefix:
First Name:LAQUANDA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAQUANDA
Other - Middle Name:
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-5104
Mailing Address - Country:US
Mailing Address - Phone:267-530-4142
Mailing Address - Fax:
Practice Address - Street 1:150 E 23RD ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-5104
Practice Address - Country:US
Practice Address - Phone:267-530-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN312988164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse