NPI 1518359736

Jessica M Gordon

Practitioner Private Vehicle Fort Wayne, IN

Practice location

Address: 4703 Highwood Dr, Fort Wayne, IN 46815-6067
Phone: (260) 797-3604

Registered specialties

Private Vehicle Primary

Transportation Services Taxonomy 347C00000X Licence 0501147343 (IN)

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Registry record

NPI: 1518359736
Entity type: Individual
Sex (as registered): Female
NPI issued: 25 Feb 2015
Record last updated: 25 Feb 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.