Provider Demographics
NPI:1497816722
Name:GORE, DAWN LYNN (CNS)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LYNN
Last Name:GORE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 TOWER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-5200
Mailing Address - Country:US
Mailing Address - Phone:440-989-4874
Mailing Address - Fax:440-989-4878
Practice Address - Street 1:1130 TOWER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-5200
Practice Address - Country:US
Practice Address - Phone:440-989-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09189-NS364SA2200X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCTP.09189OtherPRESCRIPTIVE AUTHORITY (CTP)
OH2844711Medicaid
OH2844711Medicaid