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Individual
VANESSA L MOORE
Active
Individual
VANESSA L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28148177A
IN
363LF0000X
Family Nurse Practitioner
71002478
IN
363LF0000X
Family Nurse Practitioner
Primary
71002478A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540102
MEDICARE PTAN
IN
05
—
200873510
—
IN
01
—
237042323
COMMERCIAL
IN
Enumeration date
08/28/2007
Last updated
10/30/2023
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