Healthcare Provider Details

I. General information

NPI: 1326334798
Provider Name (Legal Business Name): MICHELLE L GORSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 E STEELE ST
HERKIMER NY
13350-2421
US

IV. Provider business mailing address

PO BOX 275
CLAYVILLE NY
13322-0275
US

V. Phone/Fax

Practice location:
  • Phone: 315-868-0903
  • Fax:
Mailing address:
  • Phone: 315-839-5575
  • Fax: 315-839-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33336775
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: