Individual
CARISSA GORHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-3000
Mailing address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-3000
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
041338732
IL
Other
Enumeration date
10/03/2014
Last updated
10/03/2014
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