Provider Demographics
NPI:1093048613
Name:MOORE, EUN JUNG (LPN)
Entity Type:Individual
Prefix:
First Name:EUN JUNG
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 THOMAS ST
Mailing Address - Street 2:SPC 100
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3828
Mailing Address - Country:US
Mailing Address - Phone:907-457-3110
Mailing Address - Fax:
Practice Address - Street 1:3350 THOMAS ST
Practice Address - Street 2:SPC 100
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3828
Practice Address - Country:US
Practice Address - Phone:907-457-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6350164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse