Healthcare Provider Details

I. General information

NPI: 1033141155
Provider Name (Legal Business Name): ANNETTE RENE MOORE C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/27/2023
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E COUNTY LINE RD STE 300
INDIANAPOLIS IN
46227-1000
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-2300
  • Fax: 317-497-2502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number71000750A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: