Moore, Lola Diane

Moore, Lola Diane is an individual health care provider with primary practice located at 17714 Se Addie St Apt B , Milwaukie OR 97267-6148. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Moore, Lola Diane can be contacted via phone (503) 659-2244.

Contact Information

Primary practice address
17714 Se Addie St Apt B Milwaukie OR 97267-6148
Phone: (503) 659-2244
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 095000161RN Oregon
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 200950098NP Oregon

Profile Details

NPI number 1912143397
LBN Legal business name Moore, Lola Diane
Credentials RN, MN, PMHNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 6th, 2009
Last updated Mar 3rd, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912143397 NPPES
Oregon MEDICAID 123190

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