| NPI | 1104495001 |
|---|---|
| Former Name | MICHAELA GORDON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: MA RN2309191) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MA RN2309191) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2023-04-12 |