Healthcare Provider Details

I. General information

NPI: 1689682049
Provider Name (Legal Business Name): SUSAN C MOORE CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6605 W BROAD ST SUITE A
RICHMOND VA
23230-1714
US

IV. Provider business mailing address

6605 W BROAD ST SUITE A
RICHMOND VA
23230-1714
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-3000
  • Fax: 804-282-3314
Mailing address:
  • Phone: 804-287-3000
  • Fax: 804-282-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0015000626
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: