Individual
MELISSA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3393 16TH ST, WYANDOTTE, MI 48192-6107
(734) 363-5259
Mailing address
3393 16TH ST, WYANDOTTE, MI 48192-6107
(734) 363-5259
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703114290
MI
Other
Enumeration date
02/20/2015
Last updated
02/20/2015
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