Individual
DEJA MONE GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 RUSTY LN APT 43, RUSTON, LA 71270-8287
(318) 497-5173
Mailing address
2300 RUSTY LN APT 43, RUSTON, LA 71270-8287
(318) 497-5713
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/17/2023
Last updated
07/18/2023
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