Basic Information
| Provider Information | |||||||||
| NPI: | 1306392345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OMOORE | ||||||||
| FirstName: | LOREEN | ||||||||
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| Credential: | ACNP-AG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13634 N 93RD AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853814915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239330301 | ||||||||
| FaxNumber: | 6239330224 | ||||||||
| Practice Location | |||||||||
| Address1: | 13634 N 93RD AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853814915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239330301 | ||||||||
| FaxNumber: | 6239330224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2016 | ||||||||
| LastUpdateDate: | 08/30/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | AP8950 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.