Individual
MS. MARY ELLEN GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN CS MS
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
161364
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
478906
TUFTS
MA
01
—
PN0802
BLUE CROSS
MA
Enumeration date
06/02/2006
Last updated
01/07/2010
Update your record
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