Provider Demographics
NPI:1972746238
Name:GORDON, BARBARA JEAN (MSN)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JEAN
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18937 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1041
Mailing Address - Country:US
Mailing Address - Phone:773-834-4008
Mailing Address - Fax:773-702-6120
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 5094 ROOM G-209
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-834-3008
Practice Address - Fax:773-702-6120
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.005070364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology