Healthcare Provider Details

I. General information

NPI: 1487663118
Provider Name (Legal Business Name): HONORE S GORMLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HONORE S BECKER APRN

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LEWIS AVE STE 206
MERIDEN CT
06451-2121
US

IV. Provider business mailing address

609 WARD STREET EXT
WALLINGFORD CT
06492-4742
US

V. Phone/Fax

Practice location:
  • Phone: 203-238-9446
  • Fax: 203-238-9447
Mailing address:
  • Phone: 860-740-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE61265
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number002988
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: