Provider Demographics
NPI:1326035916
Name:MOORE, NANCY J (APN)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 THE GREEN
Mailing Address - Street 2:UNIVERSITY OF DELAWARE STUDENT HEALTH SERVICE
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19716
Mailing Address - Country:US
Mailing Address - Phone:302-831-2226
Mailing Address - Fax:302-831-6407
Practice Address - Street 1:282 THE GREEN
Practice Address - Street 2:UNIVERSITY OF DELAWARE STUDENT HEALTH SERVICE
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19716
Practice Address - Country:US
Practice Address - Phone:302-831-2226
Practice Address - Fax:302-831-6407
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000015901Medicaid
015672M49Medicare ID - Type Unspecified
DEP29101Medicare UPIN