Individual
MS. LOLA DIANE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MN, PMHNP
Contact information
Practice address
17714 SE ADDIE ST APT B, MILWAUKIE, OR 97267-6148
(503) 659-2244
Mailing address
295 AMANDA CT, OREGON CITY, OR 97045-3467
(503) 650-4431
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
095000161RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
200950098NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123190
—
OR
Enumeration date
01/06/2009
Last updated
03/03/2014
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