MEDICARE: MRS. GLORIA SUE NORDMARK

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1033247820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLORIA SUE NORDMARK

Provider Business Mailing Address
First Line	:	6627 CREEKMONT WAY
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-1841
Country	:	US
Telephone Number	:	916-723-5347
Fax Number	:	916-875-0871

Provider Business Practice Location Address
First Line	:	6627 CREEKMONT WAY
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95621-1841
Country	:	US
Telephone Number	:	916-723-5347
Fax Number	:	916-875-0871

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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