| NPI | 1912612854 |
|---|---|
| Former Name | KELLY ANN GORMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP027365) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 717012) |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2024-01-31 |