NPI 1114963451

William C Moore, CRNA

Practitioner Certified Registered Nurse Anesthetist Lake Elmo, MN

Practice location

Address: 8650 Hudson Blvd N, Lake Elmo, MN 55042-9747
Phone: (651) 702-7400
Mailing address: 14700 28th Ave N Suite 20, Plymouth, MN 55447-4835

Registered specialties

Certified Registered Nurse Anesthetist Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 367500000X Licence R070888-1 (MN)

Other Nurse Anesthetist, Certified Registered providers in Minnesota →

Registry record

NPI: 1114963451
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Jun 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.