Provider Demographics
NPI:1134408990
Name:MOORE, ANDREA CHRISTINE (RN)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:CHRISTINE
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 1:25 WARWICK ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2631
Mailing Address - Country:US
Mailing Address - Phone:774-239-3579
Mailing Address - Fax:
Practice Address - Street 1:25 WARWICK ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2631
Practice Address - Country:US
Practice Address - Phone:774-239-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2263261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse