Individual
BROOKE E MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN.CNP
Contact information
Practice address
433 W HIGH ST, BRYAN, OH 43506-1690
(419) 630-2021
(419) 630-2022
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71008662A
IN
363L00000X
Nurse Practitioner
Primary
APRN.CNP.023018
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0331865
—
OH
Enumeration date
08/22/2018
Last updated
07/01/2024
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