Individual
PATRYCE JEANALE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3840 N SHERMAN DR, INDIANAPOLIS, IN 46226-4462
(317) 541-2920
Mailing address
3840 N SHERMAN DR, INDIANAPOLIS, IN 46226-4462
(317) 541-2920
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
2350-24-0013
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200503650
—
IN
Enumeration date
03/24/2008
Last updated
03/24/2008
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