Individual
MRS. KATIE RAE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 425-5431
(260) 421-1092
Mailing address
1924 N TYLAND BLVD, NEW HAVEN, IN 46774-1546
(260) 705-5788
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27078323A
IN
Other
Enumeration date
03/27/2023
Last updated
03/27/2023
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