Healthcare Provider Details

I. General information

NPI: 1427304104
Provider Name (Legal Business Name): COLEEN E MOORE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 OLEANDER DR
WILMINGTON NC
28403-5149
US

IV. Provider business mailing address

4600 OLEANDER DR
WILMINGTON NC
28403-5149
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number252661
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number252661
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: