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Individual

MRS. ANNE MARIE MOORE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
4720 W HUNTINGTON AVE STE J, LINCOLN, NE 68524-1528
(402) 470-6055
(402) 470-6056
Mailing address
4720 W HUNTINGTON AVE, LINCOLN, NE 68524-1528
(402) 423-4218
(402) 423-4201

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
977
NE
363A00000X
Physician Assistant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4706397013
NE
Enumeration date
07/12/2006
Last updated
08/03/2021
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