Individual
CONNIE JO MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1717 W. COWLES STREET, FAIRBANKS, AK 99701
(907) 451-6682
Mailing address
PO BOX 83993, FAIRBANKS, AK 99708-3993
(907) 479-0850
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
22219
AK
Other
Enumeration date
06/18/2012
Last updated
11/28/2012
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