MEDICARE: BRITTANY MOORE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	95070281	CA

General Provider Information

NPI Number	:	1396278289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY MOORE RN

Provider Business Mailing Address
First Line	:	800 E 146TH ST
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90220-1109
Country	:	US
Telephone Number	:	404-804-7337
Fax Number	:

Provider Business Practice Location Address
First Line	:	10110 JUNIPER ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90002-3166
Country	:	US
Telephone Number	:	323-488-5915
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	04/06/2017

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