Healthcare Provider Details

I. General information

NPI: 1154690287
Provider Name (Legal Business Name): ELLEN E GORRELL CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCH ST STE 407
AKRON OH
44304-1429
US

IV. Provider business mailing address

168 E MARKET ST PO BOX 3542
AKRON OH
44308-2038
US

V. Phone/Fax

Practice location:
  • Phone: 330-384-9001
  • Fax: 330-384-9002
Mailing address:
  • Phone: 330-996-0347
  • Fax: 330-996-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCOA.12679-NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: