Individual
MARIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
894 7TH ST W, FAIRFAX, SC 29827-4880
(843) 812-8432
Mailing address
894 7TH ST W, FAIRFAX, SC 29827-4880
(843) 812-8432
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
217303
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217303
SC STATE BOARD OF NURSING
SC
Enumeration date
04/22/2015
Last updated
04/22/2015
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