Individual
MR. JEREMY GORMLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 CYPRESS ST, SULPHUR, LA 70663-5053
(337) 842-5973
Mailing address
434 CRESTWOOD ST, LAKE CHARLES, LA 70605-6820
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN122569
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP06850
LA
Other
Enumeration date
04/02/2012
Last updated
01/22/2020
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