Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 48550 | WV |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 48550 | WV |
NPI | 1073760864 |
---|---|
Provider Name | Donna H Moore |
First Address | Lewisburg, WV 24901-4049 |
Second Address | Summersville, WV 26651-1901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2008 |
Last Update Date | 31/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0035222000 | (05) | WV |
48550 | LICENSE (01) | WV |