Provider Demographics
NPI:1740220078
Name:MOORE, LINDA E (CRNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 STONEBROOK FARMS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-9655
Mailing Address - Country:US
Mailing Address - Phone:336-254-5901
Mailing Address - Fax:336-674-6353
Practice Address - Street 1:4110 STONEBROOK FARMS RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-9655
Practice Address - Country:US
Practice Address - Phone:336-254-5901
Practice Address - Fax:336-674-6353
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC075010367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC260839JMedicare ID - Type Unspecified