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Individual

NICOLE KAY MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
8118 GOOD LUCK RD, LANHAM, MD 20706-3574
(301) 324-4968
Mailing address
8118 GOOD LUCK RD, LANHAM, MD 20706-3574

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R224991
MD
390200000X
Student in an Organized Health Care Education/Training Program
RN.331366
OH

Other

Enumeration date
07/05/2016
Last updated
02/08/2019
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