Individual
NICHOLAS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 S MILL AVE, TEMPE, AZ 85281-6699
(480) 784-5500
Mailing address
912 GRANGER FARM WAY, LAS VEGAS, NV 89145-8618
(808) 387-4316
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
246503
AZ
367500000X
Certified Registered Nurse Anesthetist
834330
NV
367500000X
Certified Registered Nurse Anesthetist
NA95001207
CA
Other
Enumeration date
10/19/2019
Last updated
10/15/2021
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