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General NPI Number Information
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NPI Number | 1083605471
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Entity Type | Individual
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Provider Name | LINDY LEE MOAKE PCCNP
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Gender | Female
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1935 MOTOR ST
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City | DALLAS
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State | TX
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Zip | 75235-7701
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Country | US
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Telephone | 972-741-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 CREEK XING
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City | COPPELL
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State | TX
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Zip | 75019-6377
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Country | US
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Telephone | 214-456-7794
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Fax | 215-456-7063
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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 | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | 253922
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License Number State | TX
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