Individual
SHENELL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RMA
Contact information
Practice address
225 GOSTLIN ST, HAMMOND, IN 46327-1302
(708) 953-2575
(219) 289-9108
Mailing address
225 GOSTLIN ST, HAMMOND, IN 46327-1302
(708) 953-2575
(219) 289-9108
Taxonomy
Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
Primary
2811784
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202006291401707
HOME HEALTH
IN
Enumeration date
07/15/2020
Last updated
07/15/2020
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