Provider Demographics
NPI:1467762500
Name:MOORE, CARLENE ADELE (RN)
Entity Type:Individual
Prefix:MS
First Name:CARLENE
Middle Name:ADELE
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:P.O. BOX 1143
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95967-1143
Mailing Address - Country:US
Mailing Address - Phone:530-873-0830
Mailing Address - Fax:
Practice Address - Street 1:14706 JUILLIARD COURT
Practice Address - Street 2:
Practice Address - City:MAGALIA
Practice Address - State:CA
Practice Address - Zip Code:95954
Practice Address - Country:US
Practice Address - Phone:530-873-0830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251108163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse