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NPI Code Detail

MEDICARE: PAMELA LYNN MOORE RN FNP

MEDICARE: PAMELA LYNN MOORE RN FNP
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
1363L00000XNurse PractitionerAZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730192246
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA LYNN MOORE RN FNP
Provider Business Mailing Address
First Line : 7600 N 15TH STREET
Second Line : #130
City : PHOENIX
State : AZ
Zip : 85020-4347
Country : US
Telephone Number : 602-861-1611
Fax Number : 602-371-8929
Provider Business Practice Location Address
First Line : 7600 N 15TH STREET
Second Line : #130
City : PHOENIX
State : AZ
Zip : 85020-4347
Country : US
Telephone Number : 602-861-1611
Fax Number : 602-371-8929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2006
Last Update Date : 07/08/2007

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Directions to “ PAMELA LYNN MOORE RN FNP” Practice Location

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