MEDICARE: MS. NIDRA SUWAN MOORE R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	153190-030	WI

General Provider Information

NPI Number	:	1023263126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NIDRA SUWAN MOORE R.N.

Provider Business Mailing Address
First Line	:	4135 N COLGATE CIR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1735
Country	:	US
Telephone Number	:	414-527-1002
Fax Number	:

Provider Business Practice Location Address
First Line	:	4135 N COLGATE CIR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1735
Country	:	US
Telephone Number	:	414-527-1002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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