Provider Demographics
NPI:1447785357
Name:GORLO, ALLISON (SRNA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:GORLO
Suffix:
Gender:F
Credentials:SRNA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:PEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:99 EAST HARTFORD DRIVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108
Mailing Address - Country:US
Mailing Address - Phone:860-282-0833
Mailing Address - Fax:860-282-0170
Practice Address - Street 1:2 TRAP FALLS RD STE 414
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-7621
Practice Address - Country:US
Practice Address - Phone:203-929-3537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT390200000X
CT7373367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program