Provider Demographics
NPI:1851553721
Name:MOORE, DANA L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:KINGMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:310 MEDICAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:310 MEDICAL DR STE 101
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3078
Practice Address - Country:US
Practice Address - Phone:317-415-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28202357A163W00000X
IN71004048A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner