Doctor Name: | DR. WANDA LEA GORSUCH |
NPI Number: | 1649211566 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 6360 |
Business Practice Address: | 41 Prospect Dr Great Falls, MT - 594054123 |
Business Phone Number: | 4064553677 |
Business Fax Number: | 4064553698 |
Mailing Address: | 41 Prospect Dr, GREAT FALLS |
State: | MT |
Postal Code: | 594054123 |
Phone Number: | 4064553677 |
Fax Number: | 4064553698 |
NPI Enumeration Date: | 06/10/2006 |
NPI Last Update Date: | 12/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 6360 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MT |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |