Individual
KIM YVETTE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1540 TRINITY PL, MISHAWAKA, IN 46545-5006
(574) 272-9000
(574) 272-9295
Mailing address
1540 TRINITY PL, MISHAWAKA, IN 46545-5006
(574) 272-9000
(574) 272-9295
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27052204A
IN
Other
Enumeration date
07/25/2023
Last updated
07/25/2023
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