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Individual

MICHELE A MOORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
N.P.

Contact information

Practice address
45 N 250 W, LAGRANGE, IN 46761-8667
(260) 499-4233
(260) 499-4235
Mailing address
511 BISON BLVD, KENDALLVILLE, IN 46755-1923
(260) 927-4198
(260) 499-4233

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28159229
IN
363LF0000X
Family Nurse Practitioner
Primary
71003528A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000697704
ANTHEM
IN
05
201010140
IN
Enumeration date
02/01/2011
Last updated
02/07/2017
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