Individual
TAMELA A MOORE
Active
Individual
TAMELA A MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209.020399
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051514781
—
AL
01
—
51514781
BLUE SHIELD
AL
01
—
P00016930
PALMETTO GBA
—
Enumeration date
05/11/2006
Last updated
01/17/2020
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