Doctor Name: | SHARON MOORE |
NPI Number: | 1457338568 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | R0679525 |
Business Practice Address: | 4670 Park Nicollet Ave Se Prior Lake, MN - 553723908 |
Business Phone Number: | 9529937750 |
Business Fax Number: | |
Mailing Address: | 6465 Wayzata Blvd, Suite 315 MINNEAPOLIS |
State: | MN |
Postal Code: | 554261728 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/29/2005 |
NPI Last Update Date: | 03/31/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | R0679525 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |