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General NPI Number Information
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NPI Number | 1598037319
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Entity Type | Individual
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Provider Name | PEACE YESIDE MOORE WHNP
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Gender | Female
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 1329 BOSTON POST RD
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City | LARCHMONT
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State | NY
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Zip | 10538-3902
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Country | US
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Telephone | 929-440-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 MAYFLOWER AVE APT 1F
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City | BRONX
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State | NY
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Zip | 10461-5455
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Country | US
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Telephone | 631-316-0105
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 421069
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License Number State | NY
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