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General NPI Number Information
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NPI Number | 1013550383
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Entity Type | Individual
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Provider Name | NICHOLAS MOORE
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Gender | Male
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Dates
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Enumeration Date | 10/19/2019
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 1500 S MILL AVE
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City | TEMPE
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State | AZ
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Zip | 85281-6699
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Country | US
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Telephone | 480-784-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 912 GRANGER FARM WAY
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City | LAS VEGAS
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State | NV
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Zip | 89145-8618
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Country | US
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Telephone | 808-387-4316
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | NA95001207
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 834330
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 246503
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License Number State | AZ
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