Individual
HEATHER MICHELLE MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5091 TODD RD, FRANKLIN, OH 45005-5076
(937) 790-6577
Mailing address
5091 TODD RD, FRANKLIN, OH 45005-5076
(937) 790-6577
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN104587
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PN104587
BOARD OF NURSING
OH
Enumeration date
02/10/2012
Last updated
02/10/2012
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