Individual
HEATHER MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
1200 N TELEGRAPH RD, PONTIAC, MI 48341-1032
(248) 451-2600
Mailing address
16570 ILENE ST # A, DETROIT, MI 48221-2814
(313) 605-8082
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
4704357074
MI
Other
Enumeration date
09/14/2023
Last updated
09/14/2023
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