Individual
MARY ALMA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
607 E APACHE ST, FARMINGTON, NM 87401-6925
(505) 326-2012
(505) 326-2939
Mailing address
607 E APACHE ST, FARMINGTON, NM 87401-6925
(505) 326-2012
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
11854
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15072340
CAQH
NM
Enumeration date
03/04/2021
Last updated
03/04/2021
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