MEDICARE: MRS. AMANDA LEE MOORE RN

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	163WA2000X	Administrator Registered Nurse	95254874	CA

General Provider Information

NPI Number	:	1184555377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA LEE MOORE RN

Provider Business Mailing Address
First Line	:	2829 WATT AVE STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-6245
Country	:	US
Telephone Number	:	916-418-0828
Fax Number	:

Provider Business Practice Location Address
First Line	:	2368 MARITIME DR STE 240
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-3655
Country	:	US
Telephone Number	:	916-312-6001
Fax Number	:

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

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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