Provider Demographics
NPI:1578614731
Name:MOORE, CAROLYN JOYCE (NP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:JOYCE
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3579 FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-2356
Mailing Address - Country:US
Mailing Address - Phone:541-344-9411
Mailing Address - Fax:541-344-6519
Practice Address - Street 1:3579 FRANKLIN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-2356
Practice Address - Country:US
Practice Address - Phone:541-344-9411
Practice Address - Fax:541-344-6519
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201250193NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health