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General NPI Number Information
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NPI Number | 1013243138
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Entity Type | Individual
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Provider Name | TERESA ANN GORE ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 11 NEVINS ST SUITE 401
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City | BRIGHTON
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State | MA
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Zip | 02135
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Country | US
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Telephone | 617-782-7788
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Fax | 617-783-5657
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Provider Business Mailing Address
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Address Line | 11 NEVINS ST 4RD FLOOR
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City | BRIGHTON
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State | MA
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Zip | 02135
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Country | US
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Telephone | 617-999-2965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN280238
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License Number State | MA
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