MARY A MOORE NP NPI 1972598753

NPI Information

NPI: 1972598753
Provider Name: MARY A MOORE, NP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
215 CORPORATE DR
SUITE B
BEAVER DAM, WI
ZIP 53916
Phone: (920) 356-9415
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Mary A Moore, NP is a family nurse practitioner in Beaver Dam, WI. Mary A Moore, NP NPI is 1972598753. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

215 CORPORATE DR
SUITE B
BEAVER DAM, WI
ZIP 53916-123
Phone: (920) 356-9415
Fax: (920) 356-9477

The NPI 1972598753 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/16/2005 and was last updated on 11/12/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP2300X	Nurse Practitioner	Primary Care	1744- 033	WISCONSIN	No
2	363LF0000X	Nurse Practitioner	Family	1744-033	WISCONSIN	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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