Gorham, Carissa
Gorham, Carissa is an individual health care provider with primary practice located at 530 Ne Glen Oak Ave , Peoria IL 61637-0001. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Clinical Nurse Specialist, which is considered as her primary health care specialty. Gorham, Carissa can be contacted via phone (309) 655-3000.Contact Information
Primary practice address
530 Ne Glen Oak Ave
Peoria IL 61637-0001
Phone: (309) 655-3000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Clinical Nurse Specialist | 364S00000X | 041338732 | Illinois |
Profile Details
| NPI number | 1407259559 |
|---|---|
| LBN Legal business name | Gorham, Carissa |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 3rd, 2014 |
| Last updated | Oct 3rd, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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