Provider Demographics
NPI:1073501797
Name:MOORE, MARTIN LOUIS (APN RN)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:LOUIS
Last Name:MOORE
Suffix:
Gender:M
Credentials:APN RN
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Mailing Address - Street 1:3961 S MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-7510
Mailing Address - Country:US
Mailing Address - Phone:775-683-3444
Mailing Address - Fax:775-683-3222
Practice Address - Street 1:3961 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-7510
Practice Address - Country:US
Practice Address - Phone:775-683-3444
Practice Address - Fax:775-683-3222
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2018-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVAPN000704363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV500026966OtherMEDICARE RAILROAD
NVP67164Medicare UPIN
NVV36723Medicare PIN