Provider Demographics
NPI:1457072795
Name:GORRELL, DEANNA C (NP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:C
Last Name:GORRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 W UNIVERSITY AVE STE 401
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3433
Practice Address - Country:US
Practice Address - Phone:765-741-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013027A363L00000X, 363LG0600X
IN28250935A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP02747179OtherRAILROAD PTAN
IN1102776100OtherANTHEM PTAN
IN300068465Medicaid
INM22404281OtherMEDICARE PTAN