Individual
MRS. LISA TINGEN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1695 KERNERSVILLE MEDICAL PARKWAY, KERNERSVILLE, NC 27284
(336) 515-5000
Mailing address
4670 MERRIWEATHER RD, WINSTON SALEM, NC 27107-6430
(336) 785-0174
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
5016303
NC
Other
Enumeration date
06/03/2022
Last updated
06/03/2022
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