Provider Demographics
NPI:1447412747
Name:MOORE, BETTINA (RNFA)
Entity Type:Individual
Prefix:
First Name:BETTINA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 ROCK SPRING RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21050-2620
Mailing Address - Country:US
Mailing Address - Phone:410-879-2474
Mailing Address - Fax:410-879-8194
Practice Address - Street 1:2007 ROCK SPRING RD
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-2620
Practice Address - Country:US
Practice Address - Phone:410-879-2474
Practice Address - Fax:410-879-8194
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR131612163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant