Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 096168 | AZ |
NPI | 1114984093 |
---|---|
Provider Name | Kathleen Gorman |
First Address | Sun City, AZ 85373-5672 |
Second Address | Sacramento, CA 95817-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 13/04/2021 |