Individual
MR. MICHAEL MOORE I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
227 LOUISA AVE, POTTSVILLE, PA 17901-8689
(570) 621-2843
Mailing address
227 LOUISA AVE, POTTSVILLE, PA 17901-8689
(570) 621-2843
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN290431L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020907340001
—
PA
01
—
P00609431
RR MEDICARE
PA
Enumeration date
08/11/2005
Last updated
05/01/2009
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