| NPI | 1023769023 |
|---|---|
| Former Name | CARRIE SUSANNE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: AZ 250919) |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-04-08 |