Individual
MICHELLE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
632 BROADWAY PH 12, NEW YORK, NY 10012-2614
(347) 294-3414
(205) 332-1383
Mailing address
632 BROADWAY PH 12, NEW YORK, NY 10012-2614
(347) 294-3414
(205) 332-1383
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
209.014876
IL
363LG0600X
Gerontology Nurse Practitioner
209.014876
IL
363LP2300X
Primary Care Nurse Practitioner
Primary
209.014876
IL
Other
Enumeration date
09/29/2016
Last updated
09/05/2022
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