Gorham, Laurel A

Gorham, Laurel A is an individual health care provider with primary practice located at 2205 W Lincoln Ave , Yakima WA 98902-2437. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Gorham, Laurel A can be contacted via phone (509) 469-6305.

Contact Information

Primary practice address
2205 W Lincoln Ave Yakima WA 98902-2437
Phone: (509) 469-6305
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 201507531NP-PP Oregon
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X AP60553305 Washington
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X AP60553305 Washington

Profile Details

NPI number 1356360499
LBN Legal business name Gorham, Laurel A
Credentials Certified Pediatric Nurse Practitioner (CPNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2006
Last updated Feb 21st, 2024 - about 7 months 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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Identifiers

StateTypeNumberIssuer
All States NPI 1356360499 NPPES
Michigan MEDICAID 2972474/10
Michigan MEDICAID 2044559
Michigan MEDICAID 500693438

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