Provider Demographics
NPI:1528504081
Name:GORRELL, VERONICA (NP-C)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:GORRELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:SPONAUGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 VINEYARD TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-8847
Mailing Address - Country:US
Mailing Address - Phone:254-247-7831
Mailing Address - Fax:
Practice Address - Street 1:36065 SANTA FE AVENUE
Practice Address - Street 2:CARL R DARNALL MEDICAL CENTER
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5060
Practice Address - Country:US
Practice Address - Phone:254-553-6227
Practice Address - Fax:254-286-7188
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004172B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily