Provider Demographics
NPI:1376894998
Name:MOORE, ROBIN LEE (RN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEE
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 1:540 MCCALLIE AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2089
Mailing Address - Country:US
Mailing Address - Phone:423-634-3124
Mailing Address - Fax:
Practice Address - Street 1:540 MCCALLIE AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2089
Practice Address - Country:US
Practice Address - Phone:423-634-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN149645163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse