Healthcare Provider Details

I. General information

NPI: 1215095286
Provider Name (Legal Business Name): JONI GORES CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 BREEZY POINT RD
DULUTH MN
55803-9211
US

IV. Provider business mailing address

333 WASHINGTON AVE N STE 5000
MINNEAPOLIS MN
55401-2263
US

V. Phone/Fax

Practice location:
  • Phone: 218-343-4914
  • Fax:
Mailing address:
  • Phone: 612-659-7111
  • Fax: 612-659-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200414-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: