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General NPI Number Information
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NPI Number | 1588446991
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Entity Type | Organization
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Legal Business Name | EVAN MOORE PSYCHIATRY PLLC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 71 GRANT ST
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City | BANGOR
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State | ME
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Zip | 04401-3821
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Country | US
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Telephone | 480-235-9434
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Fax |
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Provider Business Mailing Address
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Address Line | 73 HAMMOND ST. STE 9998 PO BOX NUMBER 224
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City | BANGOR
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State | ME
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Zip | 04401
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Country | US
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Telephone | 480-235-9434
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Fax |
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Authorized Official
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Title or Position | SOLE PROVIDER, OWNER
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Name | DR. EVAN C MOORE
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Credential | DNP, PMHNP-BC
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Telephone | 480-235-9434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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