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General NPI Number Information
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NPI Number | 1275020711
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Entity Type | Individual
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Provider Name | NICOLE MARIE BAHAMONDES GORE AU.D
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Gender | Female
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 9430 PARK WEST BLVD STE 330
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City | KNOXVILLE
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State | TN
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Zip | 37923-4203
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Country | US
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Telephone | 865-693-6065
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Fax |
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Provider Business Mailing Address
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Address Line | 9430 PARK WEST BLVD STE 330
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City | KNOXVILLE
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State | TN
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Zip | 37923-4203
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Country | US
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Telephone | 865-693-6065
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 1859
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License Number State | TN
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