Individual
NATHANIEL JAMES ROBERT MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15957 FIRTREE DR, APPLE VALLEY, MN 55124-5834
(612) 558-4112
Mailing address
15957 FIRTREE DR, APPLE VALLEY, MN 55124-5834
(612) 558-4112
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
04/19/2021
Last updated
04/19/2021
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