MEDICARE: MRS. CAROL SUE GORNEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	000801	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	910761	OTHER	IA	NCCPA CERTIFICATE #
2	000801	OTHER	IA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1770563207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL SUE GORNEY PA-C

Provider Business Mailing Address
First Line	:	2942 DUBUQUE ST NE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-7915
Country	:	US
Telephone Number	:	563-357-2924
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 S CLINTON ST
Second Line	:	SUITE 195
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4034
Country	:	US
Telephone Number	:	319-384-0520
Fax Number	:	319-384-0603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	03/07/2023

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Directions to “ MRS. CAROL SUE GORNEY PA-C” Practice Location

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