Provider Demographics
NPI:1265802888
Name:GORSKI, CELIA
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:GORSKI
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 1:406 RIDGE VIEW LOOP SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-6835
Mailing Address - Country:US
Mailing Address - Phone:360-970-2695
Mailing Address - Fax:
Practice Address - Street 1:406 RIDGE VIEW LOOP SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-6835
Practice Address - Country:US
Practice Address - Phone:360-250-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA163W000X163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA$$$$$$$$$Medicaid