Provider Demographics
NPI:1760096226
Name:MOORER, LYDIA VERONICA (FNP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:VERONICA
Last Name:MOORER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:LYDIA
Other - Middle Name:VERONICA
Other - Last Name:PEMBERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:103 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1427
Mailing Address - Country:US
Mailing Address - Phone:347-463-6689
Mailing Address - Fax:
Practice Address - Street 1:103 WARWICK RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1427
Practice Address - Country:US
Practice Address - Phone:347-463-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2017025467363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily