Provider Demographics
NPI:1689495277
Name:GORA, MARCELINA ANIELA (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARCELINA
Middle Name:ANIELA
Last Name:GORA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 E OLD WILLOW RD APT 204
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-2113
Mailing Address - Country:US
Mailing Address - Phone:708-560-1900
Mailing Address - Fax:
Practice Address - Street 1:340 W BUTTERFIELD RD STE 3C
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5043
Practice Address - Country:US
Practice Address - Phone:847-852-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner