Individual
SONJA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
928 FORK ST, MUSKEGON, MI 49442-3208
(231) 638-8294
Mailing address
928 FORK ST, MUSKEGON, MI 49442-3208
(231) 638-8294
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703108186
MI
Other
Enumeration date
12/18/2014
Last updated
12/18/2014
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