Individual
MRS. EMILY LORRAINE FISHER MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP, RN
Contact information
Practice address
2222 BANCROFT WAY, BERKELEY, CA 94720-2202
(510) 642-2000
Mailing address
2222 BANCROFT WAY, BERKELEY, CA 94720-4301
(510) 642-2000
Taxonomy
Speciality
Code
Description
License number
State
163WC1400X
College Health Registered Nurse
Primary
577244
CA
363L00000X
Nurse Practitioner
15876
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00158760
—
CA
Enumeration date
07/19/2006
Last updated
03/28/2024
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