| NPI | 1760800528 |
|---|---|
| Former Name | CARLA MARIE GORMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2022009954) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 76222) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2014000944) | |
| Enumeration Date | 2014-03-30 |
| Last Update Date | 2024-02-07 |