Individual provider · NPI-1

Nicole E. Moore

Family Medicine · Milton, DE

NPI number1992457147
StatusActive
Last updated in NPPESFeb 7, 2022

Details

NPI
1992457147
Entity type
Individual (NPI-1)
Name
Nicole E. Moore
Sex
Female
Sole proprietor
Yes
Enumeration date
Jan 19, 2022
Certification date
Feb 7, 2022
Last updated
Feb 7, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineLG-0011888DEYes
163W00000X Registered NurseL1-0048126DE

Practice location

424 Mulberry St
Milton, DE 19968-1628

Phone 302-684-0561

Mailing address

424 Mulberry St
Milton, DE 19968-1628

Phone 302-684-0561

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