Individual
TINA MARIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
347 COVINGTON DR STE A, WATERLOO, IL 62298-3287
(618) 257-2200
(618) 257-2205
Mailing address
347 COVINGTON DR STE A, WATERLOO, IL 62298-3287
(618) 257-2200
(618) 257-2205
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
3000256
IL
374U00000X
Home Health Aide
3000256
IL
376J00000X
Homemaker
Primary
3000256
IL
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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