Provider Demographics
NPI:1144525429
Name:GORECKI, LORETTA MAY
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:MAY
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 1:4153 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1821
Mailing Address - Country:US
Mailing Address - Phone:708-415-6375
Mailing Address - Fax:
Practice Address - Street 1:4153 RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1821
Practice Address - Country:US
Practice Address - Phone:708-415-6375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043109696164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse