Individual
ESTELLE GLADYS MOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1450 BROADWAY ST, NILES, MI 49120-2123
(269) 861-9569
Mailing address
1450 BROADWAY ST, NILES, MI 49120-2123
(269) 861-9569
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
238237640197
MI
Other
Enumeration date
06/17/2021
Last updated
06/17/2021
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