Provider Demographics
NPI:1487259222
Name:DAWN L GORE APRN LLC
Entity type:Organization
Organization Name:DAWN L GORE APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:CCNS
Authorized Official - Phone:419-602-6402
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846-0454
Mailing Address - Country:US
Mailing Address - Phone:419-602-6402
Mailing Address - Fax:
Practice Address - Street 1:87 ELM ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:OH
Practice Address - Zip Code:44846-9740
Practice Address - Country:US
Practice Address - Phone:419-602-6402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGOtherPENDING