Provider Demographics
NPI:1053891986
Name:GORMAN, LOREN M (NP-C)
Entity type:Individual
Prefix:
First Name:LOREN
Middle Name:M
Last Name:GORMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 STAMPEDE RNCH
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1966
Mailing Address - Country:US
Mailing Address - Phone:817-705-1908
Mailing Address - Fax:
Practice Address - Street 1:209 STAMPEDE RNCH
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1966
Practice Address - Country:US
Practice Address - Phone:817-705-1908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX949732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily