Provider Information for 1356333595
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Mrs. TANYA JEAN GORMAN LADC ACADC CCGC
Sex: Female
NPI: 1356333595
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
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| NPI | 1356333595 | ||||||||||||||||
| Enumeration Date | 2005-08-15 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 13522 BIRCHWOOD AVE OMAHA, NE 68137-4223 United States Phone: 402-871-9028 | Fax: | ||||||||||||||||
| Primary Practice Address | 515 E BROADWAY COUNCIL BLUFFS, IA 51503-4419 United States Phone: 712-322-1407 | Fax:712-322-6833 | ||||||||||||||||
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