Provider Demographics
NPI:1053113506
Name:GORDON, ANGEL CHALECE (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:CHALECE
Last Name:GORDON
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7226 BRIDE WATER BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-2079
Mailing Address - Country:US
Mailing Address - Phone:616-933-1645
Mailing Address - Fax:
Practice Address - Street 1:7226 BRIDE WATER BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-2079
Practice Address - Country:US
Practice Address - Phone:616-933-1645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139436164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse