Individual
MS. FREADDIE V MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
30200 TELEGRAPH ROAD, 220, BINGHAM FARMS, MI 48025-4502
(248) 258-5058
(248) 927-5058
Mailing address
804 SCOTT NIXON MEMORIAL DRIVE, AUGUSTA, GA 30907-2464
(800) 394-4445
(706) 650-1034
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704100987
MI
367H00000X
Anesthesiologist Assistant
4704100987
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11802435
CAQH
—
05
—
4834216-10
—
MI
Enumeration date
08/30/2006
Last updated
03/30/2012
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