Healthcare Provider Details

I. General information

NPI: 1326035916
Provider Name (Legal Business Name): NANCY J MOORE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 THE GREEN UNIVERSITY OF DELAWARE STUDENT HEALTH SERVICE
NEWARK DE
19716
US

IV. Provider business mailing address

282 THE GREEN UNIVERSITY OF DELAWARE STUDENT HEALTH SERVICE
NEWARK DE
19716
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-2226
  • Fax: 302-831-6407
Mailing address:
  • Phone: 302-831-2226
  • Fax: 302-831-6407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000110
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: