Provider Demographics
NPI:1497285696
Name:MOORE, SHALANE BETH (NP-C)
Entity Type:Individual
Prefix:
First Name:SHALANE
Middle Name:BETH
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SHALANE
Other - Middle Name:BETH
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1932 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6728
Mailing Address - Country:US
Mailing Address - Phone:910-599-2391
Mailing Address - Fax:
Practice Address - Street 1:925 N 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3450
Practice Address - Country:US
Practice Address - Phone:910-202-8640
Practice Address - Fax:910-251-1540
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC245667163W00000X, 363L00000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care