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General NPI Number Information
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NPI Number | 1619392172
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Entity Type | Individual
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Provider Name | MELISSA ROSE MOORE CNM, CNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 1111 11TH ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-2105
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Country | US
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Telephone | 810-923-6043
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Fax | 505-727-4505
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Provider Business Mailing Address
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Address Line | 1111 11TH ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87104-2105
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Country | US
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Telephone | 810-923-6043
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Fax | 505-727-4505
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN-78727
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704257647
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 670
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 77534
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License Number State | NM
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