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: |