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General NPI Number Information
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NPI Number | 1245348267
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Entity Type | Individual
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Provider Name | SUSAN M MOORE APRN
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Gender | Female
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 1418 S MAIN ST STE 1
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City | OTTAWA
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State | KS
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Zip | 66067-3544
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Country | US
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Telephone | 785-229-3561
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Fax | 785-229-3529
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Provider Business Mailing Address
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Address Line | 1418 S MAIN ST STE 1
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City | OTTAWA
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State | KS
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Zip | 66067-3544
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Country | US
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Telephone | 785-229-3561
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Fax | 785-229-3529
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 45833
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 45833
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License Number State | KS
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