Healthcare Provider Details

I. General information

NPI: 1932010972
Provider Name (Legal Business Name): KARINA CYNTHIA MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N MAIN ST
WHITE RIVER JUNCTION VT
05009-0001
US

IV. Provider business mailing address

535 LEONS LN
SOUTH ROYALTON VT
05068-9504
US

V. Phone/Fax

Practice location:
  • Phone: 802-295-9363
  • Fax:
Mailing address:
  • Phone: 802-299-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number075.0065271
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: