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General NPI Number Information
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NPI Number | 1205837358
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Entity Type | Individual
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Provider Name | CHERI LYN MOORE C.R.N.A.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 05/18/2008
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Provider Practice Location Address
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Address Line | 3500 INTERSTATE 30 AT MOTLEY DR.
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City | MESQUITE
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State | TX
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Zip | 75150
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Country | US
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Telephone | 972-698-2051
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Fax |
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Provider Business Mailing Address
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Address Line | 400 VALVERDE CT
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City | SOUTHLAKE
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State | TX
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Zip | 76092-5935
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Country | US
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Telephone | 817-481-7544
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 235104
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License Number State | TX
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