Provider Demographics
NPI:1558556050
Name:MOORE, ANDREA SUE (RNFA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4708 VISTA VIEW LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-1040
Mailing Address - Country:US
Mailing Address - Phone:719-330-5512
Mailing Address - Fax:719-574-6364
Practice Address - Street 1:4708 VISTA VIEW LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-1040
Practice Address - Country:US
Practice Address - Phone:719-330-5512
Practice Address - Fax:719-574-6364
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105139163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant