Provider Demographics
NPI:1497986236
Name:GORMAN-SPANN, CAROLL
Entity Type:Individual
Prefix:MRS
First Name:CAROLL
Middle Name:
Last Name:GORMAN-SPANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 115
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446
Mailing Address - Country:US
Mailing Address - Phone:985-224-2391
Mailing Address - Fax:985-224-2392
Practice Address - Street 1:#2 DOMINICAN RD.
Practice Address - Street 2:
Practice Address - City:LAPLACE
Practice Address - State:LA
Practice Address - Zip Code:70068
Practice Address - Country:US
Practice Address - Phone:985-224-2391
Practice Address - Fax:985-224-2392
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LASIL201883747A0650X
LAPCA152593747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider