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Individual

CARLA MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
6330 W THUNDERBIRD RD, GLENDALE, AZ 85306-4002
(623) 486-6000
Mailing address
PO BOX 731, WICKENBURG, AZ 85358-0731

Taxonomy

Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
RN032313
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
687410
AZ
Enumeration date
04/13/2007
Last updated
07/09/2007
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