Provider Demographics
NPI:1083659577
Name:GORSKI, KELLY ALISON (CRNA/APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ALISON
Last Name:GORSKI
Suffix:
Gender:F
Credentials:CRNA/APRN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:GUTAUSKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA/APRN
Mailing Address - Street 1:99 EAST RIVER DR
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7301
Mailing Address - Country:US
Mailing Address - Phone:860-282-4133
Mailing Address - Fax:860-289-0742
Practice Address - Street 1:80 SEYMOUR STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5539
Practice Address - Country:US
Practice Address - Phone:860-545-2117
Practice Address - Fax:860-545-1784
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003206367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT430001129Medicare ID - Type Unspecified
D400000246Medicare PIN