Healthcare Provider Details

I. General information

NPI: 1578544946
Provider Name (Legal Business Name): HELEN A MOORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W 9TH AVE STE 220
OSHKOSH WI
54904-7247
US

IV. Provider business mailing address

2700 W 9TH AVE STE 220
OSHKOSH WI
54904-7247
US

V. Phone/Fax

Practice location:
  • Phone: 920-223-2600
  • Fax:
Mailing address:
  • Phone: 920-223-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number50538
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: