Individual
KELLI MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6300 N MAIN ST, DAYTON, OH 45415-3154
(937) 275-1500
Mailing address
6300 N MAIN ST, DAYTON, OH 45415-3154
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN.412064
OH
Other
Enumeration date
04/05/2016
Last updated
04/05/2016
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