Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN280238 | MA |
NPI | 1013243138 |
---|---|
Provider Name | Miss Teresa Ann Gore |
First Address | Brighton, MA 02135 |
Second Address | Brighton, MA 02135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2009 |
Last Update Date | 22/10/2010 |