Individual
TANISHA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
311A RIDGE RD APT 113, WILMETTE, IL 60091-3256
(267) 505-6106
Mailing address
311A RIDGE RD APT 113, WILMETTE, IL 60091-3256
(267) 505-6106
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-009934
IL
Other
Enumeration date
02/20/2023
Last updated
07/23/2024
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