Provider Demographics
NPI:1225234941
Name:MOORE, AMANDA (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 OLD COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:VA
Mailing Address - Zip Code:23149-3068
Mailing Address - Country:US
Mailing Address - Phone:804-832-6024
Mailing Address - Fax:804-758-0573
Practice Address - Street 1:1087 OLD COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:VA
Practice Address - Zip Code:23149-3068
Practice Address - Country:US
Practice Address - Phone:804-832-6024
Practice Address - Fax:804-758-0573
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001200421163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse