Individual
KEISHA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8048 N CELINA ST, MILWAUKEE, WI 53224-2904
(414) 750-8525
Mailing address
8048 N CELINA ST, MILWAUKEE, WI 53224-2904
(414) 750-8525
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
312890-31
WI
Other
Enumeration date
08/11/2016
Last updated
08/11/2016
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