Individual
VICKI DARLENE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, ACNP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7481
(503) 494-0822
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7481
(503) 494-0822
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
201809959NPPP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA122795
MEDICARE PTAN
CA
Enumeration date
10/25/2006
Last updated
01/13/2020
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