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Individual

MRS. DENISE R MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ACNP-BC

Contact information

Practice address
3850 S NATIONAL AVE, 520, SPRINGFIELD, MO 65807-5287
(417) 875-2607
(417) 875-2674
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3462

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
089074
MO
363LA2100X
Acute Care Nurse Practitioner
Primary
2010017028
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1790098580
MO
05
420017088
MO
Enumeration date
07/21/2010
Last updated
12/27/2018
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