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General NPI Number Information
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NPI Number | 1912798521
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Entity Type | Individual
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Provider Name | RYAN WILLIAM MOORE
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Gender | Male
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 300 CROSSINGS BLVD
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City | WARWICK
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State | RI
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Zip | 02886-2878
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Country | US
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Telephone | 401-777-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 30 AUDUBON RD
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City | WARWICK
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State | RI
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Zip | 02888-4602
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Country | US
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Telephone | 401-864-7778
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Fax | 401-864-7778
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CAPRN04584
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License Number State | RI
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