Individual
JACQUELINE HISTORIAN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
6256 HILLANDALE DR APT 803, LITHONIA, GA 30058-2432
(678) 913-7277
Mailing address
6256 HILLANDALE DR APT 803, LITHONIA, GA 30058-2432
(678) 913-7277
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN085771
GA
Other
Enumeration date
12/13/2011
Last updated
01/22/2014
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