Provider Demographics
NPI:1225560543
Name:MOORE, NANCY MARIA
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIA
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 1:209 ROCKY RUN RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-5413
Mailing Address - Country:US
Mailing Address - Phone:540-379-9176
Mailing Address - Fax:
Practice Address - Street 1:209 ROCKY RUN RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-5413
Practice Address - Country:US
Practice Address - Phone:540-379-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide