Individual
LISA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
10210 RIVENDELL LN, CHARLOTTE, NC 28269-7009
(704) 650-8639
Mailing address
10210 RIVENDELL LN, CHARLOTTE, NC 28269-7009
(704) 650-8639
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201730
NC
Other
Enumeration date
12/28/2020
Last updated
12/28/2020
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