Provider Demographics
NPI:1164742540
Name:GORA, DIANE MARIE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:GORA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S LAKE PARK AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6791
Mailing Address - Country:US
Mailing Address - Phone:219-942-8620
Mailing Address - Fax:219-942-6356
Practice Address - Street 1:1400 S LAKE PARK AVE STE 205
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6791
Practice Address - Country:US
Practice Address - Phone:219-942-8620
Practice Address - Fax:219-942-6356
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28062518A163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant