Provider Demographics
NPI:1033668033
Name:MOORE, CAROL (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-9500
Mailing Address - Country:US
Mailing Address - Phone:570-387-8241
Mailing Address - Fax:
Practice Address - Street 1:1199 SENECA RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-9500
Practice Address - Country:US
Practice Address - Phone:570-387-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-02
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN290482L163WP0200X
PASP003685N163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics