Provider Demographics
NPI:1346782810
Name:MOORE, BEVERLY L (APRN)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1037
Mailing Address - Country:US
Mailing Address - Phone:617-328-3440
Mailing Address - Fax:617-786-7485
Practice Address - Street 1:157 WILSON AVE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-1037
Practice Address - Country:US
Practice Address - Phone:617-328-3440
Practice Address - Fax:617-786-7485
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator