Individual
TRACY RENE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN,CSFA
Contact information
Practice address
1404 CROSS ST, SHILOH, IL 62269-2988
(618) 607-1000
Mailing address
305 MARILYN DR, NEW BADEN, IL 62265-1103
(618) 698-3620
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043116387
IL
Other
Enumeration date
11/01/2023
Last updated
11/01/2023
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