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General NPI Number Information
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NPI Number | 1528471745
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Entity Type | Individual
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Provider Name | ALYSSA MOORE APRN
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Gender | Female
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | VA BROCKTON 940 BELMONT ST BLD, 4 BASEMENT GEC
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City | BROCKTON
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State | MA
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Zip | 02301
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Country | US
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Telephone | 774-826-1842
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Fax |
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Provider Business Mailing Address
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Address Line | VA BROCKTON 940 BELMONT ST BLD, 4 BASEMENT GEC
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City | BROCKTON
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State | MA
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Zip | 02301
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Country | US
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Telephone | 774-826-3875
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN002831
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN2340503
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License Number State | MA
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