PHEBE GORDON (NPI# 1093264996) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093264996 |
| Entity Type | Individual |
| Full Name | PHEBE GORDON |
| Credential | NPC |
| Practice Address |
1027 Washington Ave Detroit Lakes MN 56501-3409 |
| Mailing Address |
Po Box 6001 Fargo ND 58108-6001 |
| Practice Telephone | 2188475611 |
| Mailing Telephone | 7013648000 |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2016-12-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
CNP 4837 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1027 WASHINGTON AVE |
| City | DETROIT LAKES |
| State | MN |
| Zip Code | 56501-3409 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063414084 | Janell Kjos | Nurse Practitioner | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2005-08-10 |
| 1962003277 | Mary C Wiczek | Nurse Practitioner | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-11-03 |
| 1760096481 | Nikki Lynn Oliver | Nurse Practitioner | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-09-01 |
| 1215548680 | Sherri L Softing | Dietitian, Registered | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-08-11 |
| 1841817384 | Rachel D Karlson | Nurse Practitioner | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-07-01 |
| 1063037489 | Caitlin Ann Kumpula | Registered Nurse | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-06-11 |
| 1225662695 | Rebecca D Peterson | Hospitalist | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-02-25 |
| 1548893183 | Katherine A Starbeck | Nurse Practitioner | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2020-02-21 |
| 1548819519 | Taylor Jones Thooft | Pharmacist | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2019-09-11 |
| 1437717618 | Connor J Camrud | Physical Therapist | 1027 Washington Ave, Detroit Lakes, MN 56501-3409 | 2019-06-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588265649 | Candace Louise Haugtvedt | Pharmacist | 321 Us-10 West, Detroit Lakes, MN 56501 | 2020-11-05 |
| 1679068407 | Strive Chiropractic Detroit Lakes LLC | Chiropractor | 1852 Nodaway Drive, Detroit Lakes, MN 56501 | 2018-06-25 |
| 1194215830 | Jordan James Reese | Registered Nurse | 1295 Bay Ridge Dr, Detroit Lakes, MN 56501 | 2018-05-17 |
| 1992179386 | Compassion House | Substance Abuse Rehabilitation Facility | 811 8th St. Se, Detroit Lakes, MN 56501 | 2015-11-23 |
| 1720344286 | Lakes Crisis & Resource Center | Clinic/Center | 1339 Pelican Lane, Detroit Lakes, MN 56501 | 2012-04-09 |
| 1063657120 | Diane Jean Mccormack | Occupational Therapist | 15840 Long Lake Road, Detroit Lakes, MN 56501 | 2008-12-03 |
| 1588817928 | Darcy Caleb Olson | Counselor | 925 Lake Ave, Detroit Lakes, MN 56501 | 2008-10-29 |
| 1760651079 | Rapidcare Urgent Care Pllc | Family Medicine | 1361 Wenner Road, Detroit Lakes, MN 56501 | 2008-02-21 |
| 1427274729 | Jeffrey C Gregory | Psychologist | 910 Lincoln Ave, Detroit Lakes, MN 56501 | 2007-04-17 |
| 1144364894 | Midwest Vision Centers Inc | Eyewear Supplier (Equipment, not the service) | 830 Washington Avenue, Detroit Lakes, MN 56501 | 2007-02-16 |
| Find all providers in zip 56501 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518587120 | Amanda Joy Dominik | Nurse Practitioner | 4411 Arden View Ct, Arden Hills, MN 55112-1944 | 2020-04-23 |
| 1881245504 | Hailey Prescott | Nurse Practitioner | 2450 Riverside Avenue Se, Minneapolis, Mn, MN 55454-1400 | 2019-09-24 |
| 1598317570 | Elisabeth Palmquist | Nurse Practitioner | 12000 Elm Creek Blvd N Ste 250, Maple Grove, MN 55369-7164 | 2019-07-10 |
| 1538644562 | Angela Ashton | Nurse Practitioner | 345 Smith Ave N Ste 404, Saint Paul, MN 55102-2346 | 2018-09-25 |
| 1558865295 | Meghan Kerry Deyo | Nurse Practitioner | 1804 7th St W Ste 200, Saint Paul, MN 55116-2300 | 2018-03-19 |
| 1336642131 | Caitlin Anna Lingbeck | Nurse Practitioner | 14001 Ridgedale Dr #100, Minnetonka, MN 55305-1781 | 2018-03-18 |
| 1740799246 | Maya Bastian | Nurse Practitioner | 12220 Travois Rd, Eden Prairie, MN 55347-4241 | 2017-09-27 |
| 1821523028 | Robin Marie Parker | Nurse Practitioner | 14135 Cedar Avenue South, Suite 100, Apple Valley, MN 55124 | 2017-04-25 |
| 1538691043 | Jenifer Flegel | Nurse Practitioner | 963 Robert St S, West Saint Paul, MN 55118-1446 | 2017-04-03 |
| 1154796811 | Megan Stark | Nurse Practitioner | 2805 Campus Dr Ste 235, Plymouth, MN 55441-2678 | 2015-12-07 |
| Find all providers with the same taxonomy | ||||
| City | DETROIT LAKES |
| Zip Code | 56501 |
Please comment or provide details below to improve the information on PHEBE GORDON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.