Provider Demographics
NPI:1790898021
Name:MOORE, ANGELA G (APRN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:G
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:G
Other - Last Name:YOUNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:365 MONTAUK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4700
Mailing Address - Country:US
Mailing Address - Phone:860-444-4737
Mailing Address - Fax:860-444-4775
Practice Address - Street 1:91 VOLUNTOWN RD
Practice Address - Street 2:NEMG YALE NEW HAVEN HOSPITAL
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379
Practice Address - Country:US
Practice Address - Phone:860-995-4778
Practice Address - Fax:860-865-2375
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q13818Medicare UPIN