| Doctor Name: | AMY MOORE |
| NPI Number: | 1073829750 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN CDE |
| License Number: | R 956714 |
| Business Practice Address: | 6401 University Ave Ne Suite 100 Fridley, MN - 554324341 |
| Business Phone Number: | 7635024877 |
| Business Fax Number: | |
| Mailing Address: | 3128 Chippewa Rd, MINNETONKA |
| State: | MN |
| Postal Code: | 553054504 |
| Phone Number: | 9526490955 |
| Fax Number: | |
| NPI Enumeration Date: | 08/19/2010 |
| NPI Last Update Date: | 08/19/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WD0400X |
| License Number: | R 956714 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Diabetes Educator |
| Taxonomy Definition: | |