Theresa Lynn Moore, LPN
Individual provider Active NPI Licensed Practical Nurse · Wayland, NY
NPI 1477844769 · NPPES record last updated Apr 21, 2011
Key facts
- NPI
- 1477844769
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 271025 (NY)
- Practice address
- 7398 Lime Kiln Rd
Wayland, NY 14572-9213 - Phone
- (585) 519-2216
- NPI assigned
- Apr 21, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 271025 | NY | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 271025 | NY | Yes |
Addresses
Primary practice location
7398 Lime Kiln Rd
Wayland, NY 14572-9213
Mailing address
7398 Lime Kiln Rd
Wayland, NY 14572-9213
Phone (585) 519-2216
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 271025 | Medicaid | NY |
Other providers in Wayland, NY
- Rachel Karr
- Ashley Kurtz
- Collette La Clair
- Mary Lou McKelvey
- Mary Meyer
- Gayle Mosher
- Samantha L Nelson
- Michelle M Osgood
- Brianna Carey Panipinto
- McKenzie Perkins
All providers in Wayland, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.