Provider Demographics
NPI:1336140391
Name:GOURLEY, DANIELLE (CRNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:URBANOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3130 GRANDVIEW RD
Mailing Address - Street 2:BUILDING B, STE. 2
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-9134
Mailing Address - Country:US
Mailing Address - Phone:717-316-3670
Mailing Address - Fax:717-316-7440
Practice Address - Street 1:3130 GRANDVIEW RD
Practice Address - Street 2:BUILDING B, STE. 2
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-9134
Practice Address - Country:US
Practice Address - Phone:717-316-3670
Practice Address - Fax:717-316-7440
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR122494363L00000X, 363LF0000X
PASP009046363LF0000X
PASP009064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD333920YBDBMedicare PIN
P78093Medicare UPIN
PA121218OtherJOHNS HOPKINS
PA1916415OtherHIGHMARK BLUE SHIELD FREE
P78093Medicare UPIN
PA1600374OtherGATEWAY MEDICARE ASSURED
PAP00394894Medicare PIN
PA50071110OtherCAPITAL BC-WGM FFM
PA50074528OtherCAPITAL BC-WMG ACWH
PA1554375OtherGATEWAY-WMG
PA50071111OtherCAPITAL BC -WMG HRFM
PA102653-FLTMedicare PIN