Provider Demographics
NPI:1902057342
Name:GORDON, ALICE HODGSON (APN)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:HODGSON
Last Name:GORDON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31189 E. 300 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:STRAWN
Mailing Address - State:IL
Mailing Address - Zip Code:61775-4095
Mailing Address - Country:US
Mailing Address - Phone:815-688-3008
Mailing Address - Fax:
Practice Address - Street 1:2550 N. ANNIE GLIDDEN RD
Practice Address - Street 2:FAMILY PLANNING CLINIC
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-1207
Practice Address - Country:US
Practice Address - Phone:815-748-2420
Practice Address - Fax:815-748-2478
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001374363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health