Provider Demographics
NPI:1487774162
Name:MOORE, JOAN LUCILLE (RN,BSN, MA)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:LUCILLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN,BSN, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9606 W MARCO POLO RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-0954
Mailing Address - Country:US
Mailing Address - Phone:623-376-4110
Mailing Address - Fax:
Practice Address - Street 1:7490 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8151
Practice Address - Country:US
Practice Address - Phone:623-376-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN102950163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse