Individual
TARA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
2301 E 93RD ST, CHICAGO, IL 60617-3913
(773) 731-9898
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
16006-33
WI
363L00000X
Nurse Practitioner
Primary
209017428
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100294044
—
WI
Enumeration date
04/05/2018
Last updated
01/14/2025
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