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General NPI Number Information
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NPI Number | 1750809919
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Entity Type | Individual
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Provider Name | BERNICE LORETTA MOORE PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 2412 GENTLE HOLLOW DR
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City | WHITEHALL
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State | PA
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Zip | 18052-3985
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Country | US
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Telephone | 347-804-3685
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 663
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City | WHITEHALL
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State | PA
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Zip | 18052-0663
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Country | US
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Telephone | 347-804-3685
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP024091
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License Number State | PA
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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 | RN648046
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License Number State | PA
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