Individual ProviderCynthia K GorrellNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140(260) 435-6722(260) 479-3514PECOS EnrollmentBased on the most recent information from CMS, provider Cynthia K Gorrell does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1316932734Provider TypeIndividualFull NameGorrell, Cynthia KCredentialNPGenderFemaleSole ProprietorNoEnumeration Date9/12/2005Last Updated10/7/2020Contact InformationPractice LocationPractice Address7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140Phone(260) 435-6722Fax(260) 435-6726Mailing LocationMailing Address6920 Pointe Inverness Way Ste 200, Fort Wayne, IN 46804-7934Phone(260) 479-3514Fax(260) 479-3520Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71000946AIndianaProvider IdentifiersIDDescriptionIssuerID200201500DescriptionMedicaidIssuerUnlistedIndianaID200945140DescriptionMedicaidIssuerUnlistedIndianaID000000675816DescriptionOtherIssuerANTHEMIndiana