Provider Demographics
NPI:1699308759
Name:GORECKI, JENNIFER M (RN, FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:GORECKI
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 GLENN DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-7836
Mailing Address - Country:US
Mailing Address - Phone:252-671-5083
Mailing Address - Fax:
Practice Address - Street 1:6950 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3025
Practice Address - Country:US
Practice Address - Phone:252-671-5083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily