Individual
DIANE MARIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
401 S BALLENGER HWY, ATTN SURGICAL SERVICES, FLINT, MI 48532-3638
(810) 342-4917
(810) 342-1335
Mailing address
401 S BALLENGER HWY, ATTN SURGICAL SERVICES, FLINT, MI 48532-3638
(810) 342-4917
(810) 342-1335
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704154335
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4376308
—
MI
01
—
DM154335
BLUE SHIELD
MI
01
—
P00002289
TRAVELER'S
MI
Enumeration date
02/13/2006
Last updated
12/11/2014
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