Provider Demographics
NPI:1164015749
Name:MOORE, MONIQUE (CD, CBE, LC)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CD, CBE, LC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 PURCELL DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-1648
Mailing Address - Country:US
Mailing Address - Phone:505-417-5291
Mailing Address - Fax:
Practice Address - Street 1:5055 PURCELL DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-1648
Practice Address - Country:US
Practice Address - Phone:505-417-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
374J00000XOtherDOULA