Individual
GRETCHEN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
111 S FRONT ST, HARRISBURG, PA 17101-2010
(717) 231-8772
(717) 231-8435
Mailing address
409 S 2ND ST STE 2F, HARRISBURG, PA 17104-1612
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA058337
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103183079
—
PA
Enumeration date
08/04/2016
Last updated
01/26/2021
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