Physician Compare National (NPI:1346788049)

HEALTHCARE PROVIDER: CHARLOTTE ALEXANDRIA GULLAP-MOORE NP

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1346788049
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0547537946
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170606000439
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GULLAP-MOORE
	Individual professional last name
Provider First Name	CHARLOTTE
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	13660 PACIFIC BREEZE DR
	Group Practice or individual's line 1 address
City	SANTA ROSA VALLEY
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	930128952
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y