Individual
JOHANNA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4110 BRIARGATE PKWY, SUITE 300, COLORADO SPRINGS, CO 80920-7835
(719) 632-7669
Mailing address
4110 BRIARGATE PKWY, SUITE 300, COLORADO SPRINGS, CO 80920-7835
(719) 632-7669
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0991887
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0991887
FNP LICENSE
CO
Enumeration date
08/03/2015
Last updated
11/21/2016
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