| NPI | 1164499208 |
|---|---|
| Former Name | EDNA FAYE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209002774) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: IL 209002774) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2013-01-08 |