Individual
DEBORAH JEAN GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ESTHETCIAN,
Contact information
Practice address
2220 COBBAN ST, BUTTE, MT 59701-5699
(503) 522-3653
Mailing address
2220 COBBAN ST, BUTTE, MT 59701-5699
(503) 522-3653
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CREATIVEBODY
—
MT
Enumeration date
01/28/2019
Last updated
01/28/2019
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