Individual
MICHAEL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3593 MEDINA RD # 181, MEDINA, OH 44256-8182
(330) 536-3746
Mailing address
3220 S LOCUST ST, DENVER, CO 80222-7410
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
478286
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0030981
OH
Other
Enumeration date
12/01/2021
Last updated
04/08/2022
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