Individual
MS. MARTHA MARY O'GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.,R.D.,L.D.N.
Contact information
Practice address
125 NORTH FIRST STREET, DEKALB, IL 60115-4311
(815) 761-4280
Mailing address
121 W ALDEN PL, DEKALB, IL 60115-4311
(815) 758-0082
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
IL
Other
Enumeration date
01/24/2007
Last updated
07/08/2007
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