Provider Demographics
NPI:1053724872
Name:GORDON, AMANDA B (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:GORDON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:YAWKEY 9E
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-724-8557
Mailing Address - Fax:617-724-8769
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAWKEY 9E
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-8557
Practice Address - Fax:617-724-8769
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2016-02-09
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Provider Licenses
StateLicense IDTaxonomies
MARN2288719363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner