1043560469 NPI number — MS. KATHERINE MARIE GORDON LMT

Table of content: MS. KATHERINE MARIE GORDON LMT (NPI 1043560469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043560469 NPI number — MS. KATHERINE MARIE GORDON LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORDON
Provider First Name:
KATHERINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043560469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
324 13 AVE SOUTH
Provider Second Line Business Mailing Address:
SUITE NO. 4
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-217-4251
Provider Business Mailing Address Fax Number:
406-315-3035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 13 AVE SOUTH
Provider Second Line Business Practice Location Address:
SUITE NO. 4
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-217-4251
Provider Business Practice Location Address Fax Number:
406-315-3035
Provider Enumeration Date:
09/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  1900 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: NO.1900 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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