Healthcare Provider Details

I. General information

NPI: 1376837989
Provider Name (Legal Business Name): KATERINA MOORE N.P.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W SOUTHERN AVE SUITE 128
PHOENIX AZ
85041-4224
US

IV. Provider business mailing address

11001 N BLACK CANYON HWY
PHOENIX AZ
85029-4757
US

V. Phone/Fax

Practice location:
  • Phone: 602-276-5563
  • Fax: 602-276-5536
Mailing address:
  • Phone: 602-942-4462
  • Fax: 602-371-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4070
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN118161
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: