Individual
MS. MICHELE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
101 WASHIGNTON STREET, HARRISBURG, PA 17104-1612
(717) 221-6258
(717) 657-7390
Mailing address
409 S 2ND ST, SUITE 2F, HARRISBURG, PA 17104-1612
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
DN001736
PA
133V00000X
Registered Dietitian
Primary
504822
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016757810003
—
PA
01
—
2818240
AETNA HMO
—
01
—
7574341
AETNA
—
01
—
DN001736
LICENSE
PA
Enumeration date
06/12/2006
Last updated
06/10/2016
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