Individual
MICHELLE GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6202
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-6202
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
729857
TX
163WA2000X
Administrator Registered Nurse
729857
TX
163WM0705X
Medical-Surgical Registered Nurse
Primary
729857
TX
163WP0200X
Pediatric Registered Nurse
729857
TX
163WP2201X
Ambulatory Care Registered Nurse
729857
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
729857
TEXAS BOARD OF NURSING
TX
Enumeration date
09/03/2014
Last updated
09/03/2014
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