Provider Demographics
NPI:1841215860
Name:MOORE, ALICE J (RN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:J
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2011
Mailing Address - Country:US
Mailing Address - Phone:985-447-0851
Mailing Address - Fax:985-447-0971
Practice Address - Street 1:303 HICKORY ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-2011
Practice Address - Country:US
Practice Address - Phone:985-447-0851
Practice Address - Fax:985-447-0971
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN071686163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse