Individual
MS. SHAUNTE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
604 PIERCE BLVD, O FALLON, IL 62269-2588
(618) 222-9244
Mailing address
132 RIDGE DR, MARYVILLE, IL 62062-5681
(618) 407-0552
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
2017000683
MO
363LP0200X
Pediatric Nurse Practitioner
Primary
209015873
IL
Other
Enumeration date
05/20/2017
Last updated
05/20/2017
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