Provider Demographics
NPI:1578379145
Name:MOORE, ALAN JAMES (RN)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:JAMES
Last Name:MOORE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-4028
Mailing Address - Country:US
Mailing Address - Phone:308-672-4907
Mailing Address - Fax:
Practice Address - Street 1:705 E OVERLAND
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3602
Practice Address - Country:US
Practice Address - Phone:308-225-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE76203163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse