SHANE EDWARD MOORE (NPI# 1982224796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982224796 |
| Entity Type | Individual |
| Full Name | SHANE EDWARD MOORE |
| Credential | DO |
| Practice Address |
1301 S Crismon Rd Mesa AZ 85209-3767 |
| Mailing Address |
1116 Franklin Ave Normal IL 61761-3514 |
| Practice Telephone | 4803586450 |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2020-04-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417426529 | Shane Moore | Nurse Practitioner | 7030 New Sanger Ave Ste 204, Waco, TX 76712-4074 | 2018-11-19 |
| 1518230747 | Shane Moore | Pharmacist | 2155 Lancaster Dr Ne, Salem, OR 97305-1228 | 2012-02-19 |
| 1639333669 | Shane D Moore IIi | Social Worker | 5707 N 22nd St, Tampa, FL 33610-4350 | 2008-07-18 |
| 1538233622 | Shane L Moore | Dentist | 2455 W Interstate 40, Amarillo, TX 79109-1852 | 2006-11-20 |
| Street Address |
1301 S CRISMON RD |
| City | MESA |
| State | AZ |
| Zip Code | 85209-3767 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366422131 | Guangming Guo | Pathology | 1301 S Crismon Rd, Mesa, AZ 85209-3767 | 2006-01-18 |
| 1336759679 | Tyler William Horge | Nurse Anesthetist, Certified Registered | 1301 S Crismon Rd, Mesa, AZ 85209-3767 | 2020-08-02 |
| 1942825880 | Bryce Bunn | Student in an Organized Health Care Education/Training Program | 1301 S Crismon Rd, Mesa, AZ 85209-3767 | 2020-06-16 |
| 1962027326 | Randal Jordan Shumway | Student in an Organized Health Care Education/Training Program | 1301 S Crismon Rd, Mesa, AZ 85209-3767 | 2020-06-11 |
| 1790300143 | Spencer Larson | Student in an Organized Health Care Education/Training Program | 1301 S Crismon Rd, Mesa, AZ 85209-3767 | 2020-06-11 |
| 1548885825 | Jennifer Kaur Sudwal | Student in an Organized Health Care Education/Training Program | 1301 S Crismon Rd, Mesa, AZ 85209-3767 | 2020-06-11 |
| 1760007116 | Victor Liao | Student in an Organized Health Care Education/Training Program | 1301 S Crismon Rd, Mesa, AZ 85209-3767 | 2020-06-11 |
| 1255956819 | Ray Moussa | Student in an Organized Health Care Education/Training Program | 1301 S Crismon Rd, Mesa, AZ 85209-3767 | 2020-06-10 |
| 1972127033 | Katherine Chen Rollins | Student in an Organized Health Care Education/Training Program | 1301 S Crismon Rd, Mesa, AZ 85209-3767 | 2020-06-04 |
| 1699398016 | Joshua Benjamin Ang | Student in an Organized Health Care Education/Training Program | 1301 S Crismon Rd, Mesa, AZ 85209-3767 | 2020-05-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013539568 | Wingfoot Wellness & Hormones LLC | Nurse Practitioner | 2500 S Power Road, Building 7 Suite 218, Mesa, AZ 85209 | 2020-05-07 |
| 1558916247 | Shiny Susan Thomas | Family Medicine | 7615,east Baseline Road, Mesa, AZ 85209 | 2019-08-08 |
| 1245798933 | Premier Care Medical Services Pllc | Clinic/Center | 7363 E Naranja Ave, Mesa, AZ 85209 | 2019-03-12 |
| 1518450568 | Mhb Services | Internal Medicine | 1301 S Crismon Road, Mesa, AZ 85209 | 2018-06-13 |
| 1174012934 | Andrew Swenson | Student in an Organized Health Care Education/Training Program | 10238 E. Hampton #406, Mesa, AZ 85209 | 2018-05-08 |
| 1689196057 | Monica R Meyer | Registered Nurse | 2424 S Rowen, Mesa, AZ 85209 | 2017-07-07 |
| 1629507041 | Rachel Ann Navarro | Occupational Therapist | 10431 E Natal Ave, Mesa, AZ 85209 | 2017-06-08 |
| 1073041331 | Michelle Resendez | Nurse Practitioner | 2500 S Power Rd, Bldg 7, Ste 218, Mesa, AZ 85209 | 2017-05-31 |
| 1275069569 | Michelle Amado | Nurse Practitioner | 2500 S. Power Rd, Bldg 7, Ste 218, Mesa, AZ 85209 | 2017-05-04 |
| 1982138079 | Warren Brent Thomas | Nurse Anesthetist, Certified Registered | 10632 E Kiva Ave, Mesa, AZ 85209 | 2017-04-14 |
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| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902410053 | Sanjhavi Agarwal | Student in an Organized Health Care Education/Training Program | 5850 E Still Cir Apt 2102, Mesa, AZ 85206-3618 | 2020-09-05 |
| 1689287542 | Victoria Lyn Slaven | Student in an Organized Health Care Education/Training Program | 1342 S Revere, Mesa, AZ 85210-5124 | 2020-08-28 |
| 1588276349 | Michael Robert Nango | Student in an Organized Health Care Education/Training Program | 5058 E Greenway St, Mesa, AZ 85205-3472 | 2020-08-21 |
| 1821600701 | Landon Merkley | Student in an Organized Health Care Education/Training Program | 120 1/2 N Wilbur, Mesa, AZ 85201-6736 | 2020-08-20 |
| 1487266524 | Brittany Alexandra Day | Student in an Organized Health Care Education/Training Program | 7325 E Mills St, Mesa, AZ 85207-2043 | 2020-08-19 |
| 1386254795 | Geneal Renee Whetten | Student in an Organized Health Care Education/Training Program | 5064 E Dartmouth Cir, Mesa, AZ 85205-6424 | 2020-08-01 |
| 1144830563 | Kaitlin Anne Benga | Student in an Organized Health Care Education/Training Program | 3060 N Ridgecrest Unit 106, Mesa, AZ 85207-1087 | 2020-08-01 |
| 1154958510 | Karzan Salih | Student in an Organized Health Care Education/Training Program | 445 S Dobson Rd Apt 1034, Mesa, AZ 85202-1827 | 2020-03-25 |
| 1689201170 | Joseph Miller | Student in an Organized Health Care Education/Training Program | 5620 E Alder Ave, Mesa, AZ 85206-1506 | 2020-03-24 |
| 1912534637 | Adam Zoltan Dregely | Student in an Organized Health Care Education/Training Program | 1440 S Clearview Ave Ste 104, Mesa, AZ 85209-3381 | 2020-03-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.