| Doctor Name: | PHYLLIS S MOORE |
| NPI Number: | 1467744979 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNSCPMHCNSBC |
| License Number: | 79712 |
| Business Practice Address: | 940 Belmont St Mclean Hospital Southeast Location Brockton, MA - 023015596 |
| Business Phone Number: | 5088948300 |
| Business Fax Number: | |
| Mailing Address: | 940 Belmont St, Mclean Hospital Southeast Location BROCKTON |
| State: | MA |
| Postal Code: | 023015596 |
| Phone Number: | 5088948300 |
| Fax Number: | |
| NPI Enumeration Date: | 05/03/2011 |
| NPI Last Update Date: | 05/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364S00000X |
| License Number: | 79712 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses and clinical experience, is expert in a specialty area of nursing practice within one or more of the components of direct patient/client care, consultation, education, research and administration. |