Healthcare Provider Details

I. General information

NPI: 1063599074
Provider Name (Legal Business Name): JEANETTE D MOORE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6678 W THUNDERBIRD RD
GLENDALE AZ
85306-3721
US

IV. Provider business mailing address

2986 E PLYMOUTH WAY
FRESNO CA
93720-5470
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-1500
  • Fax:
Mailing address:
  • Phone: 559-575-3053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNPF8880
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP2797
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: