Provider Demographics
NPI:1457513244
Name:MOORE, JONI RENAE (CRNA)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:RENAE
Last Name:MOORE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:RENAE
Other - Last Name:ORIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:411 LAUREL ST
Mailing Address - Street 2:SUITE 3170
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3017
Mailing Address - Country:US
Mailing Address - Phone:515-283-0463
Mailing Address - Fax:515-283-0794
Practice Address - Street 1:411 LAUREL ST
Practice Address - Street 2:SUITE 3170
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3017
Practice Address - Country:US
Practice Address - Phone:515-283-0463
Practice Address - Fax:515-283-0794
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079269367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered