Provider Demographics
NPI:1760841613
Name:MOORE, LINDA (RN-WCCM)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN-WCCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14502 GREENVIEW DR
Mailing Address - Street 2:408
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3287
Mailing Address - Country:US
Mailing Address - Phone:888-643-7720
Mailing Address - Fax:888-893-9435
Practice Address - Street 1:14502 GREENVIEW DR
Practice Address - Street 2:408
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3287
Practice Address - Country:US
Practice Address - Phone:888-643-7720
Practice Address - Fax:888-893-9435
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR144013163WC0400X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation