David N Moore, LSW
Individual provider Active NPI Case Manager/Care Coordinator · Balsam Lake, WI
NPI 1992929160 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992929160
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- License
- 1109 120 (WI)
- Practice address
- 100 Polk County PLZ
Suite 50
Balsam Lake, WI 54810-9071 - Phone
- (715) 485-8414
- Fax
- (715) 485-8490
- NPI assigned
- Apr 12, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 1109 120 | WI | MD | Case Manager/Care Coordinator |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | 1109 120 | WI | Yes |
Addresses
Primary practice location
100 Polk County PLZ
Suite 50
Balsam Lake, WI 54810-9071
Mailing address
PO Box 21
Balsam Lake, WI 54810-0021
Phone (715) 485-9343
Other providers in Balsam Lake, WI
- Anita Lundquist
- Kathleen M McGurran
- Brian Longhurst Merrill
- Sara C Meuth
- Kevin J Montague
- Gerry R Morgan
- Emily C Ovik
- Cynthia J Peer
- Gail Peterson
- Polk County Dept of Administration
All providers in Balsam Lake, WI · Case Manager/Care Coordinator in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.