Individual
JULIE L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4624 N SPIDER LAKE RD, TRAVERSE CITY, MI 49696-8440
(231) 947-0673
Mailing address
1105 6TH ST, TRAVERSE CITY, MI 49684-2349
(231) 947-0673
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601005691
LICENSE
MI
Enumeration date
10/16/2009
Last updated
10/29/2012
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