Most Relevant Information
Provider Data
| NPI Number: | 1003214222 |
| Provider Name: | WENDY LYNN GORDON R.D., RDH |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: | 2886 |
Most Important Dates
| Enumeration Date: | 12/22/2014 |
| Last Updated: | 12/22/2014 |
Provider Practice Location
1415 MADISON AVE
DETROIT LAKES
MN
565014542
Practice Location Phone/Fax
| Phone: | 2188447161 |
| Fax: |
Provider Mailing Location
1415 MADISON AVE
DETROIT LAKES
MN
565014542
Provider Mailing Phone/Fax
| Phone: | 2188447161 |
| Fax: |