Individual
JENNIFER HEINE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
315 S GRAND SALINE ST, CANTON, TX 75103-1355
(469) 474-1777
Mailing address
PO BOX 1494, FORNEY, TX 75126-1494
(469) 474-1777
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
332189
TX
164X00000X
Licensed Vocational Nurse
692539
CA
Other
Enumeration date
07/31/2018
Last updated
07/31/2018
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