Most Relevant Information
Provider Data
NPI Number: | 1003539792 |
Provider Name: | SAMANTHA SHYANNE GORDON CNA |
Entity Type: | Individual |
Taxonomy Code: | 374U00000X |
Specialty: | Home Health Aide |
License Number: |
Most Important Dates
Enumeration Date: | 09/19/2022 |
Last Updated: | 09/19/2022 |
Provider Practice Location
227235 TEAL AVE
WAUSAU
WI
544012557
Practice Location Phone/Fax
Phone: | 6308269753 |
Fax: |
Provider Mailing Location
16192 COASTAL HWY
LEWES
DE
199583608
Provider Mailing Phone/Fax
Phone: | |
Fax: |