Individual
MARY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
4118 WINNEMAC AVE, MADISON, WI 53711-1645
(608) 238-1426
Mailing address
602 ORCHARD DR, MADISON, WI 53711-1323
(608) 238-1426
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
148800-032
WI
Other
Enumeration date
07/07/2008
Last updated
07/29/2012
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