Provider Demographics
NPI:1457369688
Name:MOORE, LYNETTE M (NP)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:715 HORIZON DR
Mailing Address - Street 2:STE 225
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8700
Mailing Address - Country:US
Mailing Address - Phone:970-683-7107
Mailing Address - Fax:970-683-7167
Practice Address - Street 1:605 MIAMI RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4108
Practice Address - Country:US
Practice Address - Phone:970-252-3200
Practice Address - Fax:970-874-4169
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO119121163W00000X
CO2575363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse