Individual
MS. ANNALIESE JUSTINE GORHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP, FNP-BC
Contact information
Practice address
3141 CHESTNUT ST, PHILADELPHIA, PA 19104-2875
(215) 895-2000
Mailing address
556 MAIN ST APT C3, SCHWENKSVILLE, PA 19473-1021
(315) 484-8434
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
2025089303
PA
363LF0000X
Family Nurse Practitioner
Primary
2025089303
PA
Other
Enumeration date
12/30/2025
Last updated
05/04/2026
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