Provider Demographics
NPI:1871701995
Name:GORDON, ADRIANNA (CRNP)
Entity type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1550
Mailing Address - Country:US
Mailing Address - Phone:610-647-4366
Mailing Address - Fax:
Practice Address - Street 1:1776 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1550
Practice Address - Country:US
Practice Address - Phone:610-647-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ63715Medicare UPIN
PA098434Medicare ID - Type Unspecified