Provider Demographics
NPI:1376843714
Name:MOORE, SANDRA JEANNE (RN)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:JEANNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:JEANNE
Other - Last Name:ARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 COMMUNITY DRIVE
Mailing Address - Street 2:MIDWEST HEALTH CARE MANAGEMENT INC
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:68735
Mailing Address - Country:US
Mailing Address - Phone:660-885-8131
Mailing Address - Fax:660-885-4785
Practice Address - Street 1:107 W BROADWAY
Practice Address - Street 2:PATHWAY'S BEHAVIORAL HEALTH CARE
Practice Address - City:ELDORADO SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64744
Practice Address - Country:US
Practice Address - Phone:417-876-5314
Practice Address - Fax:417-876-5328
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042689163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health