Provider Demographics
NPI:1386945046
Name:GORTON, DEANNA L (RN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:L
Last Name:GORTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:L
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1968 GREENVILLE TPKE
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-3248
Mailing Address - Country:US
Mailing Address - Phone:845-672-9322
Mailing Address - Fax:
Practice Address - Street 1:1968 GREENVILLE TPKE
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-3248
Practice Address - Country:US
Practice Address - Phone:854-672-9322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY369594163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management