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General NPI Number Information
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NPI Number | 1710720628
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Entity Type | Individual
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Provider Name | GWENDOLYN MOORE MPH, RN, CHC
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Gender | Female
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 2881 SQUIRE LN
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City | MOBILE
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State | AL
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Zip | 36695-4219
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Country | US
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Telephone | 916-769-9368
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Fax |
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Provider Business Mailing Address
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Address Line | 312 SCHILLINGER RD S STE T
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City | MOBILE
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State | AL
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Zip | 36608-5032
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Country | US
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Telephone | 251-377-9760
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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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 | 1-160774
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License Number State | AL
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