Healthcare Provider Details

I. General information

NPI: 1144929183
Provider Name (Legal Business Name): LOLITA MOORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6991 E CAMELBACK RD STE D300
SCOTTSDALE AZ
85251-2492
US

IV. Provider business mailing address

3527 E ARABIAN DR
GILBERT AZ
85296-0647
US

V. Phone/Fax

Practice location:
  • Phone: 310-634-2590
  • Fax:
Mailing address:
  • Phone: 310-634-2590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number275999
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number654769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: