Individual
JILL M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1212 W SAGINAW RD, VASSAR, MI 48768-9483
(989) 823-5020
(989) 823-7881
Mailing address
PO BOX 779, TAWAS CITY, MI 48764-0779
(855) 298-9888
(989) 497-3162
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704173083
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0877585
BCBSMI
MI
01
—
150533
MEDICAID-GREATLAKES
MI
05
—
4708328
—
MI
01
—
M10200335
TRICARE
MI
Enumeration date
09/14/2005
Last updated
04/06/2021
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