Provider Demographics
NPI:1700513249
Name:MOORE, SONYA MARIE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-6818
Mailing Address - Country:US
Mailing Address - Phone:775-934-2714
Mailing Address - Fax:
Practice Address - Street 1:1680 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4387
Practice Address - Country:US
Practice Address - Phone:775-934-2714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN40252163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy