Provider Demographics
NPI:1376959692
Name:GORE, GENA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:GORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W GREEN MEADOWS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-3205
Mailing Address - Country:US
Mailing Address - Phone:317-967-7921
Mailing Address - Fax:
Practice Address - Street 1:400 W GREEN MEADOWS DR STE 110
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3205
Practice Address - Country:US
Practice Address - Phone:317-967-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY672490-1163W00000X
IN28214619A163W00000X
IN71005439B363LF0000X
IN71005439A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse