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General NPI Number Information
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NPI Number | 1073235859
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Entity Type | Individual
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Provider Name | GLORIA L MOORE FNP
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 1530 PINE GROVE AVE STE 1
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City | PORT HURON
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State | MI
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Zip | 48060-3370
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Country | US
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Telephone | 810-357-8769
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Fax |
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Provider Business Mailing Address
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Address Line | 5316 LAKESHORE RD
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3118
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Country | US
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Telephone | 810-357-8792
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Fax | 810-512-7725
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WX1500X
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Taxonomy Name | Ostomy Care Registered Nurse
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License Number | 4704263386
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 4704263386
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704263386
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License Number State | MI
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Taxonomy #8
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704301246NSA220SA
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License Number State | MI
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