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Individual
SUSAN JOHN MOORE
Active
Individual
SUSAN JOHN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71003756A
IN
363LG0600X
Gerontology Nurse Practitioner
71003756A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071250A
—
IN
Enumeration date
09/08/2011
Last updated
01/24/2023
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