Individual
CYNTHIA K GORRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 435-6722
(260) 435-6726
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71000946A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000675816
ANTHEM
IN
05
—
200201500
—
IN
05
—
200945140
—
IN
Enumeration date
09/12/2005
Last updated
10/07/2020
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