Healthcare Provider Details

I. General information

NPI: 1972549558
Provider Name (Legal Business Name): ANA C MOORE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CITATION RD SW
PATASKALA OH
43062
US

IV. Provider business mailing address

418 CITATION RD SW
PATASKALA OH
43062
US

V. Phone/Fax

Practice location:
  • Phone: 740-927-0475
  • Fax:
Mailing address:
  • Phone: 740-927-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN159705
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP03346
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.03346
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: