Individual
MS. MARYANN GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
003481
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164460
ELDERPLAN
NY
01
—
P2706184
OXFORD
NY
Enumeration date
11/23/2005
Last updated
01/27/2010
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