Doctor Name: | MS. BRENNA GRACE MOORE |
NPI Number: | 1528401577 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | IOM |
License Number: | |
Business Practice Address: | 2535 W Plata Ave Mesa, AZ - 852027860 |
Business Phone Number: | 6233352466 |
Business Fax Number: | 6233215900 |
Mailing Address: | Po Box 40823, MESA |
State: | AZ |
Postal Code: | 852740823 |
Phone Number: | 6233352466 |
Fax Number: | 6233215900 |
NPI Enumeration Date: | 04/09/2013 |
NPI Last Update Date: | 04/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171W00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Contractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering). |