Individual
MRS. JULIE ANN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
Mailing address
330 LAKEVIEW DR, GOSHEN, IN 46528-7000
(745) 331-2345
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71013765A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285348425
—
IN
Enumeration date
01/11/2023
Last updated
04/20/2023
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