Provider Demographics
NPI:1891492773
Name:TRINIDAD, MOORE LUCK (NP)
Entity Type:Individual
Prefix:
First Name:MOORE LUCK
Middle Name:
Last Name:TRINIDAD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 COUNTRY CLUB RD STE 201
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6023
Mailing Address - Country:US
Mailing Address - Phone:541-246-6613
Mailing Address - Fax:
Practice Address - Street 1:992 COUNTRY CLUB RD STE 201
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6023
Practice Address - Country:US
Practice Address - Phone:541-246-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9946363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner