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General NPI Number Information
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NPI Number | 1639431109
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Entity Type | Individual
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Provider Name | ASHLEY MARIE MOORE CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 1700 SW 7TH ST
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City | TOPEKA
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State | KS
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Zip | 66606-2489
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Country | US
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Telephone | 785-295-8359
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Fax |
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Provider Business Mailing Address
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Address Line | 2009 SW WILDWOOD LN
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City | TOPEKA
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State | KS
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Zip | 66611-1680
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Country | US
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Telephone | 785-410-3427
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 63652
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 557106
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License Number State | KS
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