MARY ELLEN GORDON CNP
NPI 1649729872
Nurse Practitioner - Family in Woodburn, IN
Active since September 29, 2016
About Mary Ellen Gordon Cnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MARY ELLEN GORDON CNP (NPI 1649729872) is an individual family provider in Woodburn, Indiana, licensed in Ohio (RN265977) and active in the NPI registry since September 2016.
NPPES Registry Identity
NPI1649729872
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMARY ELLEN GORDONCredential: CNP
Location Address18906 OLD 24Woodburn, IN 46797-9048
Mailing Address18906 Old 24Woodburn, IN 46797-9048 · (260) 493-8141 · Fax (260) 493-8181
Phone(260) 493-8141
Fax(260) 493-8181
Sole ProprietorNo
Enumeration DateSeptember 29, 2016
Last NPPES UpdateApril 1, 20262 updates tracked since enumeration
NPPES CertifiedApril 1, 2026
✔ NPI 1649729872 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Licenses✔ Licensed in OH · RN265977✔ Licensed in IN · 71012009B
18906 OLD 24, Woodburn, IN 46797
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1649729872, enumerated as an "individual" on September 29, 2016.
The provider is located at 18906 OLD 24 WOODBURN, IN 46797 and the phone number is (260) 493-8141.
Nurse Practitioner with taxonomy code 363LF0000X and a focus in Family.
