Provider Demographics
NPI:1255394995
Name:MOORE, KATHERINE KATEN (ANP-BC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:KATEN
Last Name:MOORE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MADISON AVE
Mailing Address - Street 2:DREW UNIVERSITY HEALTH SERVICE
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1434
Mailing Address - Country:US
Mailing Address - Phone:973-408-3414
Mailing Address - Fax:973-408-3031
Practice Address - Street 1:36 MADISON AVE
Practice Address - Street 2:DREW UNIVERSITY HEALTH SERVICE
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1434
Practice Address - Country:US
Practice Address - Phone:973-408-3414
Practice Address - Fax:973-408-3031
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09352500363LA2200X
NY305375363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0224766Medicaid
NJ131636AHEMedicare PIN