Provider Demographics
NPI:1578455499
Name:GORDY, JENINE LORAE MILLS
Entity type:Individual
Prefix:MRS
First Name:JENINE
Middle Name:LORAE MILLS
Last Name:GORDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHESTNUT HILL PLZ # 1229
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2761
Mailing Address - Country:US
Mailing Address - Phone:302-514-7680
Mailing Address - Fax:
Practice Address - Street 1:3 MOUNT LEBANON RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1713
Practice Address - Country:US
Practice Address - Phone:302-478-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach