Healthcare Provider Details

I. General information

NPI: 1083279202
Provider Name (Legal Business Name): ANDREA GAY GORYL APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 S HOBART BLVD APT 302
LOS ANGELES CA
90005-6603
US

IV. Provider business mailing address

700 CHIEF EDDIE HOFFMAN HWY
BETHEL AK
99559
US

V. Phone/Fax

Practice location:
  • Phone: 213-858-3075
  • Fax:
Mailing address:
  • Phone: 907-543-6948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number150221
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: