Individual
JANET LEE GORHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
120 LLANO ST, AZTEC, NM 87410-2172
(505) 334-9441
Mailing address
PO BOX 6210, FARMINGTON, NM 87499-6210
(505) 609-2258
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
161890
MT
363LF0000X
Family Nurse Practitioner
Primary
72100
NM
363LF0000X
Family Nurse Practitioner
90898
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100747570A
—
OK
05
—
200210930A
—
OK
Enumeration date
03/27/2008
Last updated
05/09/2023
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