MEDICARE: YVONNE RANAE MOORE

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	103K00000X	Behavior Analyst	45-4451933	NV

General Provider Information

NPI Number	:	1811269921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE RANAE MOORE

Provider Business Mailing Address
First Line	:	1008 BULL RUN AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5376
Country	:	US
Telephone Number	:	702-756-7762
Fax Number	:

Provider Business Practice Location Address
First Line	:	1008 BULL RUN AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5376
Country	:	US
Telephone Number	:	702-756-7762
Fax Number	:

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

Provider Enumeration Date	:	02/04/2012
Last Update Date	:	02/04/2012

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