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NPI Code Detail

MEDICARE: MRS. EILEEN M. MOORE APRN

MEDICARE: MRS. EILEEN M. MOORE APRN
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner001598CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1001598OTHERCTAPRN LICENSE NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588700538
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EILEEN M. MOORE APRN
Provider Business Mailing Address
First Line : 108 NEW LONDON TPKE
Second Line :
City : NORWICH
State : CT
Zip : 06360-2645
Country : US
Telephone Number : 860-889-3052
Fax Number : 860-889-0926
Provider Business Practice Location Address
First Line : 108 NEW LONDON TPKE
Second Line :
City : NORWICH
State : CT
Zip : 06360-2645
Country : US
Telephone Number : 860-889-3052
Fax Number : 860-889-0926
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2007
Last Update Date : 03/19/2016

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