Healthcare Provider Details
I. General information
NPI: 1154609295
Provider Name (Legal Business Name): DONNA MARIE LODGE-MOORE MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/22/2011
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
15 SW EVERETT MALL WAY STE A
EVERETT WA
98204-2715
US
IV. Provider business mailing address
1132 CARMADELLE ST
MARRERO LA
70072-2646
US
V. Phone/Fax
- Phone: 504-352-2565
- Fax:
- Phone: 504-352-2565
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | AP60359615 |
| License Number State | WA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | AP120751 |
| License Number State | TX |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 526019 |
| License Number State | NY |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | AP60359515 |
| License Number State | WA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | AP06526 |
| License Number State | LA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 21284 |
| License Number State | CA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | AP06526 |
| License Number State | LA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 21284 |
| License Number State | CA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 402939 |
| License Number State | NY |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | AP120751 |
| License Number State | TX |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | AP60359515 |
| License Number State | WA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | AP60359615 |
| License Number State | WA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
