Doctor Name: | JILL M MOORE |
NPI Number: | 1104811215 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP, BC |
License Number: | 4704173083 |
Business Practice Address: | 1212 W Saginaw Rd Vassar, MI - 487689483 |
Business Phone Number: | 9898235020 |
Business Fax Number: | 9898237881 |
Mailing Address: | 1212 W Saginaw Rd, VASSAR |
State: | MI |
Postal Code: | 487689483 |
Phone Number: | 9898235020 |
Fax Number: | 9898237881 |
NPI Enumeration Date: | 09/14/2005 |
NPI Last Update Date: | 03/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4704173083 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |