Mary A Moore, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1744-33 Issued in WI

Practice address

3801 Decorah Rd
West Bend, WI 53095-9597

Phone

(704) 529-6161

NPI assigned

Sep 16, 2005

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

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Oak Medical SC

  • Internal Medicine Physician
  • Waukesha, WI
  • NPI 1669910345
  Medicare reassignment NPD

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1972598753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 DECORAH RD",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959597",
            "telephone_number": "704-529-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 DECORAH RD",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959597",
            "telephone_number": "704-529-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARY",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-16",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "1744-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Monroe
• Erica Monzingo, SAC-IT
• Colin James Mooney, MD
• Dave James Moore, OTR/L
• Francesca Moore, DPT, PT
• Robert Moresco, PHARM. D.
• Julianne K Morrison, MS LPC
• G Michael Mosley
• Sherzing Moua, LPC-IT
• Mariam Mozaffar, PHARMD

• Family Nurse Practitioner in West Bend, WI
• Providers in West Bend, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.