Provider Demographics
NPI:1811589542
Name:GORECKI, NATALIE NICHOLE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:NICHOLE
Last Name:GORECKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 BARBERRY TREE CV
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-9573
Mailing Address - Country:US
Mailing Address - Phone:817-262-8352
Mailing Address - Fax:
Practice Address - Street 1:4805 BARBERRY TREE CV
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-9573
Practice Address - Country:US
Practice Address - Phone:817-262-8352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195040164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse