Provider Demographics
NPI:1700443785
Name:MOORE, RICHARD ROSS (RN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROSS
Last Name:MOORE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-1710
Mailing Address - Country:US
Mailing Address - Phone:907-443-3221
Mailing Address - Fax:
Practice Address - Street 1:607 DIVISION ST
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-1710
Practice Address - Country:US
Practice Address - Phone:907-443-3221
Practice Address - Fax:907-443-4869
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK143027163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health