Provider Demographics
NPI:1679104913
Name:MOE, AMY KATHRYN (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KATHRYN
Last Name:MOE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14614
Mailing Address - Country:US
Mailing Address - Phone:585-454-4930
Mailing Address - Fax:585-325-6059
Practice Address - Street 1:1 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-1111
Practice Address - Country:US
Practice Address - Phone:585-454-4930
Practice Address - Fax:585-325-6059
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY413094163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health