Provider Demographics
NPI:1780982397
Name:MOORE, SETH PATRICK (APNP, NP-C, FNP-BC)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:PATRICK
Last Name:MOORE
Suffix:
Gender:M
Credentials:APNP, NP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 N MILWAUKEE ST STE 302 PMB 693436
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4073
Mailing Address - Country:US
Mailing Address - Phone:920-819-3094
Mailing Address - Fax:
Practice Address - Street 1:139 E 2ND ST STE U
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-2420
Practice Address - Country:US
Practice Address - Phone:920-796-9831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-06
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4363-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner