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General NPI Number Information
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NPI Number | 1194826214
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Entity Type | Individual
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Provider Name | TRACY L MOORE CRNA
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 320 E NORTH AVE
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City | PITTSBURGH
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State | PA
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Zip | 15212-4756
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Country | US
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Telephone | 412-359-3155
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Fax | 412-359-3483
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Provider Business Mailing Address
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Address Line | 4135 BOARDMAN CANFIELD RD SUITE 101
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City | CANFIELD
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State | OH
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Zip | 44406-9803
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Country | US
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Telephone | 330-286-5330
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Fax | 330-286-5396
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN-268393
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN530907
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License Number State | PA
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