Healthcare Provider Details

I. General information

NPI: 1861515793
Provider Name (Legal Business Name): MICHAELENE ANN MOORE RN, ANP-C, CNS-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

158 BIG OAK TRL
BROWNS SUMMIT NC
27214-9562
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-2840
  • Fax:
Mailing address:
  • Phone: 919-360-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number215730
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number215730
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: