Active NPI
Wendy Lynn Gordon, R.D., RDH
- Registered Dietitian
- Detroit Lakes, MN
National Provider Identifier
1003214222
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2886
- Practice address
- 1415 Madison Ave
Detroit Lakes, MN 56501-4542 - Phone
- (218) 844-7161
- NPI assigned
- Dec 22, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2886 | MN | Primary |
| Registered Dietitian | 133V00000X | 839 | ND |
Addresses
Primary practice location
1415 Madison Ave
Detroit Lakes, MN 56501-4542
Mailing address
1415 Madison Ave
Detroit Lakes, MN 56501-4542
Phone (218) 844-7161
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 839 | ND | MD | Physical Therapist |
| 2886 | MN | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1419206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419206400000",
"number": "1003214222",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1415 MADISON AVE",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565014542",
"telephone_number": "218-844-7161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1415 MADISON AVE",
"city": "DETROIT LAKES",
"state": "MN",
"postal_code": "565014542",
"telephone_number": "218-844-7161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "WENDY",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "R.D., RDH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-22",
"last_updated": "2014-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MN",
"license": "2886",
"primary": true
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ND",
"license": "839",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit Lakes, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.