Individual
DESTINEY M MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
972 33RD ST SE, GRAND RAPIDS, MI 49508-2435
(646) 775-8413
Mailing address
763 5TH ST NW # 2, GRAND RAPIDS, MI 49504-5159
(646) 775-8413
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Enumeration date
01/20/2025
Last updated
01/20/2025
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