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General NPI Number Information
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NPI Number | 1093641706
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Entity Type | Individual
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Provider Name | CORINNE MOORE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/20/2026
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Last Update Date | 06/20/2026
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Provider Practice Location Address
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Address Line | 5011 PEARL ST
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City | AMO
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State | IN
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Zip | 46103-7724
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Country | US
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Telephone | 317-445-2695
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 183
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City | AMO
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State | IN
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Zip | 46103-0183
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Country | US
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Telephone |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 28198928A
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License Number State | IN
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