Provider Demographics
NPI:1396024246
Name:GORMAN, ALEXIS (FNP)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SPRINGFIELD RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1790
Mailing Address - Country:US
Mailing Address - Phone:413-562-5173
Mailing Address - Fax:413-562-1716
Practice Address - Street 1:75 SPRINGFIELD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1790
Practice Address - Country:US
Practice Address - Phone:413-562-5173
Practice Address - Fax:413-562-1716
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN269788363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care