Provider Demographics
NPI:1497033286
Name:MOORE, PAMELA SUE (FNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PLAZA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-7729
Mailing Address - Country:US
Mailing Address - Phone:740-695-9321
Mailing Address - Fax:
Practice Address - Street 1:103 PLAZA DR
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-7729
Practice Address - Country:US
Practice Address - Phone:740-695-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH329292163W00000X
WV55726163W00000X
WV2011013830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily