Individual
SANDRA J. MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1425 MAIN ST N, PINE CITY, MN 55063-6026
(320) 629-7505
(320) 629-2202
Mailing address
1425 MAIN ST N, PINE CITY, MN 55063-6026
(320) 629-7505
(320) 629-2202
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
157868
WI
363LF0000X
Family Nurse Practitioner
Primary
R 181983-4
MN
Other
Enumeration date
04/24/2007
Last updated
11/12/2020
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