Healthcare Provider Details

I. General information

NPI: 1497816722
Provider Name (Legal Business Name): DAWN LYNN GORE CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 PARK EAST DR STE 211
BEACHWOOD OH
44122-4312
US

IV. Provider business mailing address

3619 PARK EAST DR STE 211
BEACHWOOD OH
44122-4312
US

V. Phone/Fax

Practice location:
  • Phone: 216-464-6210
  • Fax: 216-464-6212
Mailing address:
  • Phone: 216-464-6210
  • Fax: 216-464-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCOA.09189-NS
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCOA.09189-NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: