Healthcare Provider Details

I. General information

NPI: 1962343145
Provider Name (Legal Business Name): MORGAN ANNE MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 1ST ST
SPRINGFIELD IL
62781-0001
US

IV. Provider business mailing address

2229 N 5TH ST
SPRINGFIELD IL
62702-1763
US

V. Phone/Fax

Practice location:
  • Phone: 217-788-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041438317
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: