Provider Demographics
NPI:1568728319
Name:MOORE, ALICE C (CPM)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:C
Last Name:MOORE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 LOVE RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-1723
Mailing Address - Country:US
Mailing Address - Phone:440-935-0569
Mailing Address - Fax:
Practice Address - Street 1:4907 LOVE RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-1723
Practice Address - Country:US
Practice Address - Phone:440-935-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84100R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife