Healthcare Provider Details
I. General information
NPI: 1811205586
Provider Name (Legal Business Name): LOLITA ANNETTE MOORE RN, BSN, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 09/16/2010
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6 WINTERMIST CT
SACRAMENTO CA
95831-3813
US
IV. Provider business mailing address
7600 RUSH RIVER DR APT 82
SACRAMENTO CA
95831-5511
US
V. Phone/Fax
- Phone: 916-643-5250
- Fax: 866-687-7640
- Phone: 916-643-3758
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC2100X |
| Taxonomy | Continence Care Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0200X |
| Taxonomy | Critical Care Medicine Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC3500X |
| Taxonomy | Cardiac Rehabilitation Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WD0400X |
| Taxonomy | Diabetes Educator Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0500X |
| Taxonomy | Infusion Therapy Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WM0705X |
| Taxonomy | Medical-Surgical Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WN0300X |
| Taxonomy | Nephrology Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0000X |
| Taxonomy | Pain Management Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP2201X |
| Taxonomy | Ambulatory Care Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WX0800X |
| Taxonomy | Orthopedic Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WX1500X |
| Taxonomy | Ostomy Care Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WG0000X |
| Taxonomy | General Practice Registered Nurse |
| License Number | 548409 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
