Individual
MRS. TAMMY JO MORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1300 W 2ND ST, ROCK FALLS, IL 61071-1005
(815) 626-2230
Mailing address
1300 W 2ND ST., ROCK FALLS, IL 61071-1005
(815) 626-2230
(815) 626-3729
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-001786
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-001786
ILLINOIS LICENSE NUMBER
IL
01
—
1035875
PA CERTIFICATION NUMBER
IL
01
—
1528008034
ORGANIZATION NPI NUMBER
IL
Enumeration date
11/29/2006
Last updated
07/12/2017
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