Healthcare Provider Details

I. General information

NPI: 1265654743
Provider Name (Legal Business Name): CYNTHIA N MOORE LIC. AC., MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 US ROUTE 5
WESTMINSTER VT
05158-9651
US

IV. Provider business mailing address

PO BOX 2
WESTMINSTER STATION VT
05159-0002
US

V. Phone/Fax

Practice location:
  • Phone: 802-722-4023
  • Fax: 802-722-4137
Mailing address:
  • Phone: 802-722-4023
  • Fax: 802-722-4137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number091-0000010
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: