Healthcare Provider Details

I. General information

NPI: 1669135422
Provider Name (Legal Business Name): COURTNEY MOORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HUNTER LN
CAMP HILL PA
17011-2400
US

IV. Provider business mailing address

412 65TH WAY SW
TUMWATER WA
98501-5423
US

V. Phone/Fax

Practice location:
  • Phone: 717-761-2633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN60254916
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: