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General NPI Number Information
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NPI Number | 1376741462
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Entity Type | Individual
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Provider Name | DIANNE FREEMAN-MOORE NP
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Gender | Female
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 819 WOODMERE DR
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City | LAFAYETTE
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State | IN
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Zip | 47905-5604
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Country | US
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Telephone | 765-448-4646
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Fax | 765-448-4791
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Provider Business Mailing Address
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Address Line | 819 WOODMERE DR
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City | LAFAYETTE
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State | IN
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Zip | 47905-5604
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Country | US
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Telephone | 765-448-4646
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Fax | 765-448-4791
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 71002438A
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License Number State | IN
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