Provider Demographics
NPI:1770563207
Name:GORNEY, CAROL SUE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:SUE
Last Name:GORNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:SUE
Other - Last Name:NORVEISAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2942 DUBUQUE ST NE
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-7915
Mailing Address - Country:US
Mailing Address - Phone:563-357-2924
Mailing Address - Fax:
Practice Address - Street 1:201 S CLINTON ST
Practice Address - Street 2:SUITE 195
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4034
Practice Address - Country:US
Practice Address - Phone:319-384-0520
Practice Address - Fax:319-384-0603
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000801363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA910761OtherNCCPA CERTIFICATE #
IA000801OtherMEDICAL LICENSE
IA000801OtherMEDICAL LICENSE
IAR80977Medicare UPIN
IA000801OtherMEDICAL LICENSE
IA59519Medicare ID - Type UnspecifiedWYOMING LOCATION
IAI14210028Medicare PIN