Individual
SHAWNAS MONIQUE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3007 DR WILLIAM G WEATHERS DR, LOUISVILLE, KY 40211-1891
(312) 957-4247
Mailing address
113 HILLSIDE CIR, CHARLESTOWN, IN 47111-1008
(312) 957-4247
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
700005277
KY
1744P3200X
Prosthetics Case Management
Primary
700005277
KY
Other
Enumeration date
11/06/2019
Last updated
02/03/2020
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