Individual
TAMMY SUE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
4000 WELLNESS DR, MIDLAND, MI 48670-9147
(989) 615-2923
Mailing address
4000 WELLNESS DR, MIDLAND, MI 48670-9147
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704280850
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704280850NSA2107H
AGACNP-BC
MI
05
—
4704280850NSA2107H
—
MI
Enumeration date
04/15/2021
Last updated
09/10/2021
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