Provider Demographics
NPI:1649629205
Name:GORMAN, MICHELLE ANNETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ANNETTE
Last Name:GORMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2981 SANDSTONE ST
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-7387
Mailing Address - Country:US
Mailing Address - Phone:209-988-2819
Mailing Address - Fax:
Practice Address - Street 1:2981 SANDSTONE ST
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-7387
Practice Address - Country:US
Practice Address - Phone:209-988-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-05
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500434163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy