Provider Demographics
NPI:1639129364
Name:ERTEL-MOORE, DENISE ELAINE (MSN, APRN, NP-BC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ELAINE
Last Name:ERTEL-MOORE
Suffix:
Gender:F
Credentials:MSN, APRN, NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CYPRESS CREEK PKWY
Mailing Address - Street 2:SUITE 334
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3530
Mailing Address - Country:US
Mailing Address - Phone:281-802-6054
Mailing Address - Fax:281-817-5863
Practice Address - Street 1:7887 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2013
Practice Address - Country:US
Practice Address - Phone:281-802-6054
Practice Address - Fax:281-817-5863
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2014-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX616776363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNP7255OtherBCBSTX
TX827N81OtherBC/BS W/TRUMEN
TX096174005Medicaid
TXNP7255OtherBCBSTX
TXS75301Medicare UPIN
TX613344Medicare PIN