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NPI Code Detail

MEDICARE: JILL M GORTON CRNP

MEDICARE: JILL M GORTON CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerSP009130PA

General Provider Information

NPI Number : 1255531489
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL M GORTON CRNP
Provider Business Mailing Address
First Line : 1885 MARKET ST
Second Line :
City : WARREN
State : PA
Zip : 16365-1277
Country : US
Telephone Number : 814-726-4047
Fax Number : 814-726-4045
Provider Business Practice Location Address
First Line : 1885 MARKET ST
Second Line :
City : WARREN
State : PA
Zip : 16365-1277
Country : US
Telephone Number : 814-726-4047
Fax Number : 814-726-4045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2007
Last Update Date : 01/24/2022

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