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General NPI Number Information
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NPI Number | 1164742540
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Entity Type | Individual
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Provider Name | DIANE MARIE GORA REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 1400 S LAKE PARK AVE STE 205
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City | HOBART
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State | IN
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Zip | 46342-6791
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Country | US
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Telephone | 219-942-8620
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Fax | 219-942-6356
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Provider Business Mailing Address
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Address Line | 1400 S LAKE PARK AVE STE 205
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City | HOBART
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State | IN
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Zip | 46342-6791
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Country | US
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Telephone | 219-942-8620
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Fax | 219-942-6356
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 28062518A
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License Number State | IN
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