Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tara Rae Gordijenko

Individual provider Licensed Practical Nurse · NPI 1104749837

Tara Rae Gordijenko is a Licensed Practical Nurse in Bunker Hill, West Virginia. Practices as a sole proprietor. Licensed in Maryland.

Licensed in
MD
In the registry since
2026

Practice location Address checks out

210 Isaac Dr
Bunker Hill, WV 25413-4267
Phone: (681) 273-9995
Fax: (681) 227-9995
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Licensed Practical Nurse (primary) Taxonomy 164W00000X · Licence LP55602 (MD)

Record details

NPI number1104749837
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJuly 31, 2026
Last updated in NPPESJuly 31, 2026
Certification dateJuly 31, 2026
Mailing address210 Isaac Dr, Bunker Hill, WV 25413-4267

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