Provider Demographics
NPI:1104134113
Name:MOORE, JO-ANN M (RN, MSN, ANP-C)
Entity type:Individual
Prefix:
First Name:JO-ANN
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN, MSN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1681 CRANSTON ST STE D
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5000
Mailing Address - Country:US
Mailing Address - Phone:401-946-8446
Mailing Address - Fax:401-946-8340
Practice Address - Street 1:65 EDDIE DOWLING HWY
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-7305
Practice Address - Country:US
Practice Address - Phone:401-597-5353
Practice Address - Fax:401-769-4555
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37578363LA2200X
RIAPRN01013363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001939101Medicare PIN