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Individual

MISS TINJA CAMILLA MOORE

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
2647 N HOLTON ST, MILWAUKEE, WI 53212-2928
(414) 265-5113
Mailing address
2647 N HOLTON ST, MILWAUKEE, WI 53212-2928
(414) 265-5113

Taxonomy

Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
39991300
WI
Enumeration date
05/03/2006
Last updated
07/09/2007
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