Provider Demographics
NPI:1023327038
Name:MOORE, GEMMA B (RN, MHA, RAT-CT,LNHA)
Entity type:Individual
Prefix:MRS
First Name:GEMMA
Middle Name:B
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN, MHA, RAT-CT,LNHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 OSBORN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5746
Mailing Address - Country:US
Mailing Address - Phone:646-924-7554
Mailing Address - Fax:
Practice Address - Street 1:628 OSBORN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5746
Practice Address - Country:US
Practice Address - Phone:646-924-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY436043163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator