Healthcare Provider Details

I. General information

NPI: 1386945046
Provider Name (Legal Business Name): DEANNA L GORTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANNA L BROWN RN

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 GREENVILLE TPKE
PORT JERVIS NY
12771-3248
US

IV. Provider business mailing address

1968 GREENVILLE TPKE
PORT JERVIS NY
12771-3248
US

V. Phone/Fax

Practice location:
  • Phone: 854-672-9322
  • Fax:
Mailing address:
  • Phone: 845-672-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number369594
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: