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General NPI Number Information
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NPI Number | 1184391146
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Entity Type | Individual
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Provider Name | AMANDA CAYE MOORE DNP
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Gender | Female
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 222 SOUTHWAY AVE STE 2B
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City | LEWISTON
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State | ID
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Zip | 83501-2703
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Country | US
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Telephone | 208-799-5370
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Fax |
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Provider Business Mailing Address
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Address Line | 415 6TH STREET ATTN: PHYSICIAN SERVICES
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City | LEWISTON
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State | ID
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Zip | 83501-2424
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Country | US
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Telephone | 208-750-7462
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Fax | 208-750-7467
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP61196279
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 69128
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License Number State | ID
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