ALISSA A GORDON (NPI# 1326563917) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326563917 |
| Entity Type | Individual |
| Full Name | ALISSA A GORDON |
| Other Name | ALISSA A HUECHTEMAN |
| Credential | APN, DNP |
| Practice Address |
2750 11th St Rock Island IL 61201 |
| Mailing Address |
500 W River Dr Davenport IA 52801-1014 |
| Practice Telephone | 5633363000 |
| Practice Fax Number | 5633272102 |
| Mailing Telephone | 5633363000 |
| Mailing Fax Number | 5633363125 |
| Enumeration Date | 2017-08-04 |
| Last Update Date | 2018-07-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
209016237 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 1598759292 | 05 | |
| IL | ILLINIOS MEDICARE | F400408026 | 01 |
| IA | IOWA MEDICARE | 132380068 | 01 |
| IA | 1326563917 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 708 15th Ave, East Moline, IL 612442134 | 5633363000 | 5633363212 |
| 1106 4th Ave, Moline, IL 612651231 | 5633363000 | 5633272045 |
| 2200 3rd Ave, Rock Island, IL 612018840 | 5633363000 | 5633363125 |
| 500 W River Dr, Davenport, IA 528011014 | 5633363000 | 5633363125 |
| 925 S 4th St, Clinton, IA 527325726 | 5633363000 | 5633333025 |
| 1510 E Rusholme St, Davenport, IA 528032463 | 5633363000 | 5633441371 |
| 303 W 6th St, Davenport, IA 528035101 | 5633363000 | 5633363125 |
| Street Address |
2750 11TH ST |
| City | ROCK ISLAND |
| State | IL |
| Zip Code | 61201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952395972 | Bernardita R Enriquez | Pediatrics | 2750 11th St, Rock Island, IL 61201-5216 | 2005-09-06 |
| 1427561216 | Melina Moncivaiz | Nurse Practitioner | 2750 11th St, Rock Island, IL 61201-5216 | 2017-11-15 |
| 1568813459 | Manisha Virdi | Dentist | 2750 11th St, Rock Island, IL 61201-5216 | 2016-06-22 |
| 1669874608 | Heidi Vorac | Nurse Practitioner | 2750 11th St, Rock Island, IL 61201-5216 | 2014-09-22 |
| 1780004275 | Rebecca Hayes | Internal Medicine | 2750 11th St, Rock Island, IL 61201 | 2014-04-23 |
| 1568759520 | Sarah Lynn Hartman | Pediatrics | 2750 11th St, Rock Island, IL 61201-5216 | 2011-06-28 |
| 1417139452 | Kendra R Kaufman | Physician Assistant | 2750 11th St, Rock Island, IL 61201-5216 | 2007-12-01 |
| 1780894816 | Sanjay Suryakant Pancholi | Internal Medicine | 2750 11th St, Rock Island, IL 61201-5216 | 2007-05-24 |
| 1598759292 | Community Health Care, Inc. | Clinical Medical Laboratory | 2750 11th St, Rock Island, IL 61201-5216 | 2005-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689206245 | Judy Kay Moore | Technician | 2439 8th Ave, Rock Island, IL 61201 | 2020-02-11 |
| 1053956862 | Christina Beam | Counselor | 1413 40th Street, Rock Island, IL 61201 | 2019-11-15 |
| 1356843817 | Stephanie Kaye Jones | Counselor | 2701 17th St., Rock Island, IL 61201 | 2018-03-01 |
| 1073062030 | Innovative Transport Enterprise, LLC | Non-emergency Medical Transport (VAN) | 2239 24th Street Apt 15c, Rock Island, IL 61201 | 2016-09-30 |
| 1124575733 | Robert Young Center | Community Based Residential Treatment Facility, Mental Illness | 2701 - 17 Street, Rockisland, IL 61201 | 2016-09-01 |
| 1538520903 | James Keith Frainey | Psychologist | 805 19th Street, Transitions Mhs, Rock Island, IL 61201 | 2016-03-14 |
| 1417340837 | Brandon Lee Sachwitz | Physician Assistant | 2701 17th Street, Trinity Medical Center, Rock Island, IL 61201 | 2015-03-10 |
| 1215366679 | Kimberly Lyall | Physical Therapy Assistant | 767 30th Street, Rock Island, IL 61201 | 2013-11-06 |
| 1386080745 | The Abbey Center, LLC | Clinic/Center | 3031 5th Ave., Rock Island, IL 61201 | 2013-05-13 |
| 1487097382 | Joe Lee Westerhof | Veterinarian | 2529 11th St, Rock Island, IL 61201 | 2013-04-10 |
| Find all providers in zip 61201 | ||||
| Taxonomy Code | 363LG0600X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Gerontology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316553472 | Nicholas Johnson | Nurse Practitioner | 8455 S Luella Ave, Chicago, IL 60617-1953 | 2020-09-23 |
| 1710592175 | Mary Maloney | Nurse Practitioner | 348 Westglen Dr, Glen Carbon, IL 62034-1002 | 2020-09-12 |
| 1134738800 | Benjamin Scott Hulfachor | Nurse Practitioner | 4143 N Central Park Ave Apt G, Chicago, IL 60618-2062 | 2020-07-28 |
| 1083222368 | Izolda Rosario | Nurse Practitioner | 501 W Lake St Ste 207, Elmhurst, IL 60126-1419 | 2020-07-22 |
| 1043832785 | Melanie Glander | Nurse Practitioner | 18357 Cowing Ct, Homewood, IL 60430-3332 | 2020-05-16 |
| 1699306902 | Ife Muyiwa-ojo | Nurse Practitioner | 729 E Carpenter St, Springfield, IL 62702-5321 | 2020-01-27 |
| 1962040345 | Doctors Orders Inc. | Nurse Practitioner | 5113 S Harper Ave Ste 2, Chicago, IL 60615-4119 | 2019-12-16 |
| 1801455993 | Parul Arora | Nurse Practitioner | 1717 W Congress Pkwy Ste 1125, Chicago, IL 60612-3809 | 2019-06-11 |
| 1891358222 | Kelly Jo Erke | Nurse Practitioner | 20830 N 1970 East Rd, Danville, IL 61834-6228 | 2019-04-22 |
| 1689136319 | Brittany Sue Borkowski | Nurse Practitioner | 5841 S Maryland Ave # W700, Chicago, IL 60637-1443 | 2019-04-02 |
| Find all providers with the same taxonomy | ||||
| City | ROCK ISLAND |
| Zip Code | 61201 |
Please comment or provide details below to improve the information on ALISSA A 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.