Individual
DONNA H MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
211 MERCHANTS WALK, SUMMERSVILLE, WV 26651-1901
(304) 872-9455
Mailing address
PO BOX 1049, LEWISBURG, WV 24901-4049
(304) 645-4043
(304) 645-4713
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
48550
WV
363LP2300X
Primary Care Nurse Practitioner
Primary
48550
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0035222000
—
WV
01
—
48550
LICENSE
WV
Enumeration date
08/22/2008
Last updated
10/31/2014
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