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General NPI Number Information
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NPI Number | 1609706753
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Entity Type | Individual
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Provider Name | TRISCHELLA MOORE
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Gender | Female
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Dates
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Enumeration Date | 05/20/2026
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 1236 E 53RD ST
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City | CHICAGO
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State | IL
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Zip | 60615-4008
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Country | US
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Telephone | 773-231-0957
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 288461
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City | CHICAGO
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State | IL
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Zip | 60628-8421
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Country | US
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Telephone |
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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 | 209035678
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License Number State | IL
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