Individual
KELLYANNA J MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2200 NW 26TH ST, OWATONNA, MN 55060-5503
(507) 451-1120
(507) 444-6287
Mailing address
2200 NW 26TH ST, OWATONNA, MN 55060-5503
(507) 451-1120
(507) 444-6287
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
44578
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
854628200
—
MN
Enumeration date
03/29/2006
Last updated
10/25/2024
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