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General NPI Number Information
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NPI Number | 1760730139
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Entity Type | Individual
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Provider Name | DANA MARIE MOORE APRN
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Gender | Female
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 1349 N MOUNT AUBURN RD
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63701-1727
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Country | US
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Telephone | 573-334-9564
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Fax | 573-334-1879
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Provider Business Mailing Address
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Address Line | 2601 NORTH ST
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City | SCOTT CITY
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State | MO
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Zip | 63780-1227
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Country | US
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Telephone | 573-576-7056
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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 | 2012022143
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License Number State | MO
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