Individual
DEANNA C GORRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2525 W UNIVERSITY AVE STE 401, MUNCIE, IN 47303-3433
(765) 741-5730
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28250935A
IN
363L00000X
Nurse Practitioner
71013027A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71013027A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102776100
ANTHEM PTAN
IN
05
—
300068465
—
IN
01
—
M22404281
MEDICARE PTAN
IN
01
—
P02747179
RAILROAD PTAN
IN
Enumeration date
09/06/2022
Last updated
09/27/2024
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