Provider Demographics
NPI:1518585025
Name:GORMUS, COURTNEY MARIE (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:MARIE
Last Name:GORMUS
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MARIE
Other - Last Name:GILREATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4616 W PALE MOON LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5036
Mailing Address - Country:US
Mailing Address - Phone:804-339-9084
Mailing Address - Fax:
Practice Address - Street 1:4616 W PALE MOON LN
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84009-5036
Practice Address - Country:US
Practice Address - Phone:804-339-9084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8742207-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily