Provider Demographics
NPI:1164864153
Name:MOORE, CHRISTINE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10495 MONTGOMERY RD STE 25
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4420
Mailing Address - Country:US
Mailing Address - Phone:513-865-1631
Mailing Address - Fax:
Practice Address - Street 1:10495 MONTGOMERY RD STE 25
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4420
Practice Address - Country:US
Practice Address - Phone:513-865-1631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14143-NP363LW0102X
OHAPRN.CNP.14143363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health