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General NPI Number Information
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NPI Number | 1114267572
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Entity Type | Individual
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Provider Name | GWENDOLYN CALLA MOORE CPNP
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Gender | Female
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Dates
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Enumeration Date | 02/22/2013
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 148 EAST AVE STE 3G
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City | NORWALK
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State | CT
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Zip | 06851-5727
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Country | US
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Telephone | 203-838-4034
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Fax | 203-853-6361
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Provider Business Mailing Address
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Address Line | 148 EAST AVE STE 3G
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City | NORWALK
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State | CT
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Zip | 06851-5727
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Country | US
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Telephone | 203-838-4034
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Fax | 203-853-6351
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 382340
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 10129
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License Number State | CT
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