Individual
LYNNA MOENGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1820 W MOSS AVE, PEORIA, IL 61606-1645
(815) 614-0046
Mailing address
1820 W MOSS AVE, PEORIA, IL 61606-1645
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01055332
TX
Other
Enumeration date
10/05/2021
Last updated
10/05/2021
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