Healthcare Provider Details

I. General information

NPI: 1588913271
Provider Name (Legal Business Name): SHARON MARIE GORMAN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BEN WALTERS
HOMER AK
99603
US

IV. Provider business mailing address

3959 BEN WALTERS
HOMER AK
99603
US

V. Phone/Fax

Practice location:
  • Phone: 907-235-3436
  • Fax:
Mailing address:
  • Phone: 907-235-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number15582
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number302
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: