Provider Demographics
NPI:1710513239
Name:MOORE, SUZANNE F (CALM)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:F
Last Name:MOORE
Suffix:
Gender:F
Credentials:CALM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 S BELT LINE RD STE 148
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4182
Mailing Address - Country:US
Mailing Address - Phone:214-396-5288
Mailing Address - Fax:469-660-0065
Practice Address - Street 1:5801 RAYBURN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-3026
Practice Address - Country:US
Practice Address - Phone:682-707-2524
Practice Address - Fax:469-660-0065
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20553605OtherDRIVER LICENSE