Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95002601 | CA |
NPI | 1003298324 |
---|---|
Provider Name | Gordon Worley |
First Address | Loomis, CA 95650-2011 |
Second Address | Woodland, CA 95695-5131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2015 |
Last Update Date | 08/07/2015 |