Healthcare Provider Details

I. General information

NPI: 1609706753
Provider Name (Legal Business Name): TRISCHELLA MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 E 53RD ST
CHICAGO IL
60615-4008
US

IV. Provider business mailing address

PO BOX 288461
CHICAGO IL
60628-8421
US

V. Phone/Fax

Practice location:
  • Phone: 773-231-0957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209035678
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: