Provider Demographics
NPI:1376837989
Name:MOORE, KATERINA (NP-C)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 N BLACK CANYON HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4757
Mailing Address - Country:US
Mailing Address - Phone:602-942-4462
Mailing Address - Fax:602-371-2002
Practice Address - Street 1:3535 W SOUTHERN AVE
Practice Address - Street 2:SUITE 128
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-4224
Practice Address - Country:US
Practice Address - Phone:602-276-5563
Practice Address - Fax:602-276-5536
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN118161163W00000X
AZAP4070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse