Individual
JOANNA LEIGH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
661 E MAIN ST, PERU, IN 46970-2662
(765) 472-2519
(765) 400-4465
Mailing address
8003 CASTLEWAY DR, INDIANAPOLIS, IN 46250-1946
(175) 761-3353
(317) 343-6562
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28164395A
IN
363LF0000X
Family Nurse Practitioner
Primary
71009786A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300036259
—
IN
Enumeration date
12/20/2019
Last updated
02/08/2023
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