Healthcare Provider Details

I. General information

NPI: 1598841660
Provider Name (Legal Business Name): ANNE MARIE MOORE WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 HIGHWAY 99 N STE 110
EUGENE OR
97402-2643
US

IV. Provider business mailing address

PO BOX 498
ELMIRA OR
97437-0498
US

V. Phone/Fax

Practice location:
  • Phone: 541-848-6183
  • Fax: 541-848-6183
Mailing address:
  • Phone: 541-848-6183
  • Fax: 541-848-6183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number200650102
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number200650102NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: