Provider Demographics
NPI:1891850087
Name:MOORE, DEBRA M (RD, LMNT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-4476
Mailing Address - Country:US
Mailing Address - Phone:402-563-4022
Mailing Address - Fax:
Practice Address - Street 1:4600 38TH ST
Practice Address - Street 2:COLUMBUS COMMUNITY HOSPITAL
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1664
Practice Address - Country:US
Practice Address - Phone:402-562-4460
Practice Address - Fax:402-562-3378
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE328133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE81052OtherCCH BCBS MNT PROV
NE275263Medicare ID - Type UnspecifiedCCH MNT