Provider Demographics
NPI:1679517783
Name:MOORE, JANE L (FNP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13204 W UTAH CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4228
Mailing Address - Country:US
Mailing Address - Phone:303-986-3495
Mailing Address - Fax:
Practice Address - Street 1:5500 E PEAKVIEW AVE
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121
Practice Address - Country:US
Practice Address - Phone:973-661-8300
Practice Address - Fax:973-661-8333
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118138363LF0000X
CO10158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO423896505Medicaid
MO000080515Medicare ID - Type Unspecified