Individual
MRS. ROSALYN RUSSELL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN BSN
Contact information
Practice address
2051 W GRAND BLVD, DETROIT, MI 48208-1105
(313) 961-3200
Mailing address
21951 HARDING ST, OAK PARK, MI 48237-2556
(248) 968-0564
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704130380
MI
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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