Provider Demographics
NPI:1396804167
Name:MOORE, SANDRA (MSN, ARNP-BC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MSN, ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OF STATE 2401 E ST NW
Mailing Address - Street 2:M MED QI, SA 1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20522-0001
Mailing Address - Country:US
Mailing Address - Phone:703-875-4846
Mailing Address - Fax:703-875-4850
Practice Address - Street 1:OF STATE 2401 E ST NW
Practice Address - Street 2:M MED QI, SA 1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0001
Practice Address - Country:US
Practice Address - Phone:703-875-4846
Practice Address - Fax:703-875-4853
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN0000011105OtherADVANCED PRACTICE NURSE