Individual
DESTINY MOOTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
475 EASTDALE DR, DAYTON, OH 45415-2913
(937) 626-6868
Mailing address
4950 NORTHCUTT PL, DAYTON, OH 45414-3840
(937) 496-2020
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
168599
OH
Other
Enumeration date
08/26/2018
Last updated
06/05/2023
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