Healthcare Provider Details

I. General information

NPI: 1104134113
Provider Name (Legal Business Name): JO-ANN M MOORE RN, MSN, ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 01/30/2021
Certification Date: 01/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 EDDIE DOWLING HWY
NORTH SMITHFIELD RI
02896-7305
US

IV. Provider business mailing address

1681 CRANSTON ST STE D
CRANSTON RI
02920-5000
US

V. Phone/Fax

Practice location:
  • Phone: 401-597-5353
  • Fax: 401-769-4555
Mailing address:
  • Phone: 401-946-8446
  • Fax: 401-946-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNPP37578
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN01013
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: