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General NPI Number Information
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NPI Number | 1063500486
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Entity Type | Individual
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Provider Name | KATHLEEN ANNE MOORE RNC NNP
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Gender | Female
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-5006
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Country | US
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Telephone | 216-844-1922
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Fax |
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Provider Business Mailing Address
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Address Line | 26452 CHAPEL HILL DR
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-1808
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Country | US
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Telephone | 440-716-9752
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN218648
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License Number State | OH
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