Individual
MRS. SARA JANE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
200 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-4502
(616) 914-1693
Mailing address
PO BOX 5329, SAGINAW, MI 48603-0329
(616) 364-6700
(989) 401-4235
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704265117
MI
Other
Enumeration date
09/19/2019
Last updated
10/08/2019
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