Individual
MARY GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
4967 CROOKS RD STE 130, TROY, MI 48098-5812
(248) 952-1601
(734) 402-0254
Mailing address
4967 CROOKS RD, STE. 130, TROY, MI 48098-5801
(248) 952-1601
(248) 952-0192
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704079294
MI
Other
Enumeration date
01/30/2006
Last updated
11/15/2013
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