Provider Demographics
NPI:1841365574
Name:MOORE, ELIZABETH A (CNP, MSN)
Entity type:Individual
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First Name:ELIZABETH
Middle Name:A
Last Name:MOORE
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Gender:F
Credentials:CNP, MSN
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Mailing Address - Street 1:323 MARION AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3639
Mailing Address - Country:US
Mailing Address - Phone:330-837-1111
Mailing Address - Fax:330-837-1769
Practice Address - Street 1:821 ANOLA ST
Practice Address - Street 2:SUITE C
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2075
Practice Address - Country:US
Practice Address - Phone:330-343-7581
Practice Address - Fax:330-343-1456
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-07-02
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Provider Licenses
StateLicense IDTaxonomies
OHRN277214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily