Provider Demographics
NPI:1447866082
Name:MOORE, MELISSA (FNP-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 EAGLE DR # 311
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-8020
Mailing Address - Country:US
Mailing Address - Phone:970-412-2395
Mailing Address - Fax:
Practice Address - Street 1:1332 LINDEN ST STE 1
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3289
Practice Address - Country:US
Practice Address - Phone:720-600-4637
Practice Address - Fax:720-815-0443
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1000038363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily