Dawnelle Marie-Vargas Gordon, PMHNP-BC, ARNP, APNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

209005943 Issued in IL

Practice address

2150 W Harrison St
Chicago, IL 60612-3706

Phone

(312) 942-5375

NPI assigned

Apr 11, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Dawnelle Marie Nicholson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dahlia Center for Perinatal Mental Health PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Rockford, IL
  • NPI 1033714944
  NPD (past)
• Abbe Center for Community Mental Health, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cedar Rapids, IA
  • NPI 1366299018
  NPD (past)
• Community Mental Health Center for Mid-Eastern Iowa

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Iowa City, IA
  • NPI 1124097134
  NPD (past)
• Hillcrest Family Services

  • Primary Care Clinic/Center
  • Dubuque, IA
  • NPI 1497354773

  Psychiatric/Mental Health

  NPD (past)
• United Community Services, Inc.

  • Point of Service
  • West Des Moines, IA
  • NPI 1609998137
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1780647586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123706",
            "telephone_number": "312-942-5375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 W HARRISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123706",
            "telephone_number": "312-942-5375"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1023 Shady Oaks Dr",
            "address_purpose": "LOCATION",
            "city": "Dubuque",
            "state": "IA",
            "postal_code": "52003",
            "country_code": "US",
            "telephone_number": "563-676-7509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "DAWNELLE",
        "middle_name": "MARIE-VARGAS",
        "credential": "PMHNP-BC, ARNP, APNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-11",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209005943",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209005943",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G-113375",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "7345-33",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11851721",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAWNELLE",
            "last_name": "NICHOLSON",
            "middle_name": "MARIE",
            "credential": "MSN, PMHNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bradley Jennings Gordon, M.D.
• Brenda Jo Gordon, DDS
• Colette Gordon, MD
• Daniel Adam Gordon, LCSW
• Darwin Gordon
• Dmitri Gordon
• Eddie O Gordon, PHARM D
• Elaine Aaren Gordon, LCSW, CADC
• Emily Gordon, MSW, M.ED, LCSW, CST
• Erin B Gordon, M.S.W., L.C.S.W.

• Psychiatric/Mental Health Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.