Provider Demographics
NPI:1992107411
Name:MOORE, DANA LEWIS (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LEWIS
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1528
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-1528
Mailing Address - Country:US
Mailing Address - Phone:478-272-1366
Mailing Address - Fax:478-277-1251
Practice Address - Street 1:104 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2500
Practice Address - Country:US
Practice Address - Phone:478-272-1366
Practice Address - Fax:478-277-1251
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN123301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily