Individual
SHAWN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1410 WASHINGTON BLVD, APT 1706, DETROIT, MI 48226-1719
(313) 646-5591
Mailing address
1410 WASHINGTON BLVD, APT 1706, DETROIT, MI 48226-1719
(313) 646-5591
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M600765081141
—
MI
Enumeration date
12/11/2015
Last updated
12/11/2015
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