Provider Demographics
NPI:1760966774
Name:MOORE, MOLLY MICHELLE (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:MICHELLE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51 W 3RD ST STE 500
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-2871
Mailing Address - Country:US
Mailing Address - Phone:480-237-5098
Mailing Address - Fax:877-358-8109
Practice Address - Street 1:51 W 3RD ST STE 500
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2871
Practice Address - Country:US
Practice Address - Phone:480-237-5098
Practice Address - Fax:877-358-8109
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily