Provider Demographics
NPI:1053810762
Name:GORDON, SHERYL LYNN (MSN, RN)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:LYNN
Last Name:GORDON
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 LOS LUNAS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4927
Mailing Address - Country:US
Mailing Address - Phone:505-264-1370
Mailing Address - Fax:
Practice Address - Street 1:3530 GIBSON BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87116-3200
Practice Address - Country:US
Practice Address - Phone:505-255-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR27198163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR27198OtherNEW MEXICO STATE BOARD OF NURSING