Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95009397 | CA |
NPI | 1003395864 |
---|---|
Provider Name | Christine Marie Moak |
First Address | Long Beach, CA 90808-4002 |
Second Address | Long Beach, CA 90808-4002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2018 |
Last Update Date | 11/08/2018 |