Provider Demographics
NPI:1508063355
Name:MOOSE, ANN GREEN (MSN, RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:GREEN
Last Name:MOOSE
Suffix:
Gender:F
Credentials:MSN, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 ROYALTY CIR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8230
Mailing Address - Country:US
Mailing Address - Phone:704-437-1384
Mailing Address - Fax:
Practice Address - Street 1:1893 E BROAD ST # B-4
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-4307
Practice Address - Country:US
Practice Address - Phone:704-766-1000
Practice Address - Fax:704-766-1002
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily