Individual
DEASIA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10 JOSEPHINE DR, WASHINGTONVILLE, NY 10992-1000
(917) 577-7791
Mailing address
10 JOSEPHINE DR, WASHINGTONVILLE, NY 10992-1000
(917) 577-7791
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
722968
NY
164W00000X
Licensed Practical Nurse
323577
NY
Other
Enumeration date
05/25/2016
Last updated
11/21/2024
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