Individual
DEANA GAY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
108 W MARKET ST, BLOOMINGTON, IL 61701-3918
(309) 827-5351
Mailing address
5 OAKBROOK CT APT 1, BLOOMINGTON, IL 61704-2242
(309) 530-6075
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
041269898
IL
Other
Enumeration date
01/22/2009
Last updated
01/22/2009
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