| NPI | 1659763928 |
|---|---|
| Former Name | TERESA RAE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MN 3692) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MN 3692) |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2026-05-06 |