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Individual
SHANNON DENISE MOORE
Active
Individual
SHANNON DENISE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
43074378
IL
Other
Enumeration date
07/24/2007
Last updated
07/24/2007
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