Provider Demographics
NPI:1235360587
Name:MOORE, ANNE M (FNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4911 VAN NUYS BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1716
Mailing Address - Country:US
Mailing Address - Phone:818-986-9308
Mailing Address - Fax:
Practice Address - Street 1:4911 VAN NUYS BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1716
Practice Address - Country:US
Practice Address - Phone:818-986-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily