NPI 1093264996 · live from the CMS NPI Registry
Phebe Gordon, NPC
Nurse Practitioner, Pediatrics in Detroit Lakes, MN. National Provider Identifier 1093264996, active.
NPI record
| NPI | 1093264996 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 1027 Washington Ave, Detroit Lakes, MN 56501 |
| Practice phone | 218-847-5611 |
| Mailing address | Po Box 6001, Fargo, ND 58108 |
| Enumerated | October 3, 2016 |
| Last updated | December 21, 2016 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics primary | 363LP0200X | CNP 4837 (MN) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.