Healthcare Provider Details

I. General information

NPI: 1972522647
Provider Name (Legal Business Name): EMILY LORRAINE FISHER MOORE NP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY FISHER MOORE

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY
BERKELEY CA
94720-2202
US

IV. Provider business mailing address

2222 BANCROFT WAY
BERKELEY CA
94720-4301
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-2000
  • Fax:
Mailing address:
  • Phone: 510-642-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15876
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number577244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: