Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN241256 | GA |
NPI | 1003090150 |
---|---|
Provider Name | Ms. Donna A Moore |
First Address | Grayson, GA 30017-7940 |
Second Address | Valley Stream, NY 11580-2145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2007 |
Last Update Date | 23/04/2019 |