Provider Demographics
NPI:1598841660
Name:MOORE, ANNE MARIE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 498
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:OR
Mailing Address - Zip Code:97437-0498
Mailing Address - Country:US
Mailing Address - Phone:541-848-6183
Mailing Address - Fax:541-848-6183
Practice Address - Street 1:116 HIGHWAY 99 N STE 110
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-2643
Practice Address - Country:US
Practice Address - Phone:541-848-6183
Practice Address - Fax:541-848-6183
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650102363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health