Healthcare Provider Details

I. General information

NPI: 1144094368
Provider Name (Legal Business Name): CHRISTINA LYNN MOORE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

4413 MILGATE ST FL 2
PITTSBURGH PA
15224-1526
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5052
  • Fax:
Mailing address:
  • Phone: 814-598-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberSP027565
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: