Individual
MISS CAROL A MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
25706 CRAFT AVE, ROSEDALE, NY 11422-3010
(718) 730-0529
Mailing address
25706 CRAFT AVE, ROSEDALE, NY 11422-3010
(718) 730-0529
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F309373-01
NY
Other
Enumeration date
03/30/2021
Last updated
03/30/2021
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