Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 071005035 | IL |
Y | 103T00000X | Psychologist | 071005035 | IL |
N | 102L00000X | Psychologist | 2362 | TN |
N | 103T00000X | Psychologist | 2362 | TN |
NPI | 1013221175 |
---|---|
Provider Name | Dr. Gloria Marta Workman |
First Address | Joint Base Lewis Mcchord, WA 98438-1303 |
Second Address | Joint Base Lewis Mcchord, WA 98438-1303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2010 |
Last Update Date | 06/08/2013 |