Healthcare Provider Details

I. General information

NPI: 1780993436
Provider Name (Legal Business Name): MOORE DAVOCK RN, CNOR, CRNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 MERIDIAN AVE N SUITE 270
SEATTLE WA
98133-9451
US

IV. Provider business mailing address

10330 MERIDIAN AVE N SUITE 270
SEATTLE WA
98133-9451
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-6360
  • Fax: 206-368-6361
Mailing address:
  • Phone: 206-368-6360
  • Fax: 206-368-6361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP2800X
TaxonomyPerioperative Clinical Nurse Specialist
License Number056261
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00106544
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: