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Individual

THOMAS MOORE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PMHNP-BC

Contact information

Practice address
66 CLUB RD STE 140, EUGENE, OR 97401-2491
(541) 345-1722
Mailing address
159 N SANGAMON ST STE 200, CHICAGO, IL 60607-2201
(309) 397-2415

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
202002591RN
OR
163W00000X
Registered Nurse
RN61231272
WA
163WP0808X
Psychiatric/Mental Health Registered Nurse
041393235
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202002776NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
209017885
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP61231376
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500778964
OR
05
500801827
OR
Enumeration date
11/01/2013
Last updated
03/01/2023
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