Provider Demographics
NPI:1639715006
Name:MOORE, CADEATRIZLIUS SHAWNQUITIA (CRNP)
Entity type:Individual
Prefix:
First Name:CADEATRIZLIUS
Middle Name:SHAWNQUITIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22136 MEDICAL VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-2940
Mailing Address - Country:US
Mailing Address - Phone:256-648-5598
Mailing Address - Fax:
Practice Address - Street 1:22136 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-2940
Practice Address - Country:US
Practice Address - Phone:256-648-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-126814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily