Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 333276 | NY |
NPI | 1003090606 |
---|---|
Provider Name | Catherine E Gore |
First Address | Ray Brook, NY 12977-0300 |
Second Address | Ray Brook, NY 12977-0300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2007 |
Last Update Date | 19/12/2007 |