Individual
SANDRA MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2296 TORCH LAKE DR, FORNEY, TX 75126-0877
(413) 847-1561
Mailing address
2296 TORCH LAKE DR, FORNEY, TX 75126-0877
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
228169
TX
Other
Enumeration date
05/28/2020
Last updated
05/28/2020
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