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General NPI Number Information
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NPI Number | 1922476456
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Entity Type | Individual
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Provider Name | REANNA MOORE RDN
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Gender | Female
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 2121 NORTH AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6428
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Country | US
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Telephone | 970-263-2829
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Fax |
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Provider Business Mailing Address
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Address Line | 1807 N 4TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-2101
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Country | US
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Telephone | 904-477-3409
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APN.0997864-NP
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86006872
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License Number State | CO
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