Most Relevant Information
Provider Data
| NPI Number: | 1003350570 |
| Provider Name: | BREANNA N GORE |
| Entity Type: | Individual |
| Taxonomy Code: | 247200000X |
| Specialty: | Technician, Other |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/18/2016 |
| Last Updated: | 12/18/2016 |
Provider Practice Location
2080 WHITTAKER RD # 164
YPSILANTI
MI
481978238
Practice Location Phone/Fax
| Phone: | 7347960259 |
| Fax: |
Provider Mailing Location
2080 WHITTAKER RD # 164
YPSILANTI
MI
481978238
Provider Mailing Phone/Fax
| Phone: | 7347960259 |
| Fax: |