Maranda Gourley, MPH, MSN, PNP-PC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

9041 Issued in CT

Practice address

50 Grand Ave
New Haven, CT 06513-3949

Phone

(203) 777-7411

NPI assigned

Mar 2, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Maranda Hyde Former name

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mhyde373019@direct.ynhh.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fair Haven Community Health Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • New Haven, CT
  • NPI 1104803444
  Medicare reassignment NPD
• Fair Haven Community Health Clinic, Inc

  • Community/Retail Pharmacy
  • Branford, CT
  • NPI 1760051486
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612828800000",
    "number": "1730713512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 BISHOP ST FL 3",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065113718",
            "telephone_number": "507-450-8262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 GRAND AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065133949",
            "telephone_number": "203-777-7411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Lock St",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065113603",
            "country_code": "US",
            "telephone_number": "203-432-0206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOURLEY",
        "first_name": "MARANDA",
        "credential": "MPH, MSN, PNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-02",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "CT",
            "license": "153396",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "9041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARANDA",
            "last_name": "HYDE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Andrew Gottlieb-Cohen, LCSW
• Carlos Rodrigo Goulart, MD
• Bonnie Elyssa Gould Rothberg, MD PHD MPH
• Michael E Gould, PA
• Michael Goulet, PT
• Antony Gout, MD
• Michael John Gouzoulis
• Shraddha Govani
• Shree Priya Govindarajan
• Veenita F Govinden, MSW

• Pediatric Nurse Practitioner in New Haven, CT
• Providers in New Haven, CT by specialty
• Pediatric Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.