Provider Demographics
NPI:1730167891
Name:MOORE, JESSIE M (APRN)
Entity type:Individual
Prefix:MS
First Name:JESSIE
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:330 ORCHARD ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4417
Mailing Address - Country:US
Mailing Address - Phone:203-789-4154
Mailing Address - Fax:203-867-5507
Practice Address - Street 1:330 ORCHARD ST
Practice Address - Street 2:SUITE 309
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4417
Practice Address - Country:US
Practice Address - Phone:203-789-4154
Practice Address - Fax:203-867-5507
Is Sole Proprietor?:No
Enumeration Date:2006-01-08
Last Update Date:2013-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT002823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily