Jill Moore, RN, CDE

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

License

4704150144 Issued in MI

Practice address

829 N Center Ave Ste 140
Gaylord, MI 49735-1598

Phone

(989) 731-7872

Fax

(989) 731-7833

NPI assigned

May 1, 2014

Last updated

May 1, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Munson Healthcare Otsego Memorial Hospital

  dba MHC Great Lakes Plastic Surgery & Skin Center- Petoskey

  • Plastic Surgery Physician
  • Petoskey, MI
  • NPI 1770374530
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398902400000",
    "number": "1639589526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 N OTSEGO AVE",
            "address_2": "SUITE 1",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351568",
            "telephone_number": "989-731-7708",
            "fax_number": "989-731-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 N CENTER AVE STE 140",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351598",
            "telephone_number": "989-731-7872",
            "fax_number": "989-731-7833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "JILL",
        "name_prefix": "Mrs.",
        "credential": "RN, CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-01",
        "last_updated": "2014-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "MI",
            "license": "4704150144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John David Moffat, M.D.
• Adam Derek-Alan Moffatt, PA
• Megan Louise Montgomery, LMT
• Nicole Montgomery, LMSW
• Sandra K Montgomery
• Joseph Harold Moore, LPC
• Mark Edward Moore Jr., PTA
• Michael Andrew Morey, LMSW,ACSW
• Nancy Lorene Morgridge, MA LPC NCC CCJP
• Pamela Mae Morgridge, MA, LPC, CAADC

• Diabetes Educator Registered Nurse in Gaylord, MI
• Providers in Gaylord, MI by specialty
• Diabetes Educator Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.