Provider Demographics
NPI:1992205959
Name:GORE, ANGELA TOMPLAIT (LVN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:TOMPLAIT
Last Name:GORE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5529 ARIOLA LN
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-9733
Mailing Address - Country:US
Mailing Address - Phone:409-201-9973
Mailing Address - Fax:
Practice Address - Street 1:3330 FANNIN ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3801
Practice Address - Country:US
Practice Address - Phone:409-832-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176667164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse