Individual
EZEQUIEL R MORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN FNP-BC
Contact information
Practice address
954 W STATE ST, SYCAMORE, IL 60178-1335
(815) 895-9144
Mailing address
1373 OMEGA CIRCLE DR, DEKALB, IL 60115-5832
(815) 501-5393
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
041.408204
IL
363LF0000X
Family Nurse Practitioner
Primary
209.025250
IL
Other
Enumeration date
04/26/2022
Last updated
05/27/2022
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