Individual
LISA E GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
404 N KEENE ST, COLUMBIA, MO 65201-6626
(573) 875-9224
(573) 875-9284
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
124308
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127254
BLUE SHIELD
MO
01
—
787653
HEALTHLINK
MO
05
—
917307001
—
MO
Enumeration date
04/24/2007
Last updated
11/05/2020
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