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General NPI Number Information
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NPI Number | 1861155178
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Entity Type | Individual
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Provider Name | ANGELA VICTORIA MOORE MSN, FNP-C, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/14/2021
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 850 W BARAGA AVE
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City | MARQUETTE
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State | MI
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Zip | 49855-4550
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Country | US
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Telephone | 906-449-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 RYAN AVE APT 4
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City | MARQUETTE
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State | MI
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Zip | 49855-1281
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Country | US
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Telephone | 586-202-3763
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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 | 4704290287
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704290287
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License Number State | MI
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