Provider Demographics
NPI:1467781062
Name:MOORE, ELIZABETH ADAIR (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ADAIR
Last Name:MOORE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 SW 105TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5487
Mailing Address - Country:US
Mailing Address - Phone:503-430-1777
Mailing Address - Fax:503-430-0226
Practice Address - Street 1:6800 SW 105TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5487
Practice Address - Country:US
Practice Address - Phone:503-430-1777
Practice Address - Fax:503-430-0226
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201350074NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health