Provider Demographics
NPI:1487663118
Name:GORMLEY, HONORE S (APRN)
Entity Type:Individual
Prefix:MRS
First Name:HONORE
Middle Name:S
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:HONORE
Other - Middle Name:S
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:609 WARD STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4742
Mailing Address - Country:US
Mailing Address - Phone:860-740-6811
Mailing Address - Fax:
Practice Address - Street 1:455 LEWIS AVE STE 206
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-238-9446
Practice Address - Fax:203-238-9447
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE61265163W00000X
CT002988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004245602Medicaid