Provider Demographics
NPI:1144618281
Name:MOORE, JANET
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1398
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0309
Mailing Address - Country:US
Mailing Address - Phone:509-527-8153
Mailing Address - Fax:509-527-8255
Practice Address - Street 1:19 SOUTHPOINT LN
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4175
Practice Address - Country:US
Practice Address - Phone:509-527-8153
Practice Address - Fax:509-527-8255
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00146363163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse