Provider Demographics
NPI:1811205586
Name:MOORE, LOLITA ANNETTE (RN, BSN, MBA)
Entity Type:Individual
Prefix:MS
First Name:LOLITA
Middle Name:ANNETTE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN, BSN, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 RUSH RIVER DR APT 82
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5511
Mailing Address - Country:US
Mailing Address - Phone:916-643-3758
Mailing Address - Fax:
Practice Address - Street 1:6 WINTERMIST CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3813
Practice Address - Country:US
Practice Address - Phone:916-643-5250
Practice Address - Fax:866-687-7640
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548409163WC2100X, 163W00000X, 163WC0200X, 163WC3500X, 163WD0400X, 163WC0400X, 163WH0200X, 163WI0500X, 163WM0705X, 163WN0300X, 163WP0000X, 163WP2201X, 163WX0800X, 163WX1500X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WN0300XNursing Service ProvidersRegistered NurseNephrology
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care