Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW291 | FL |
NPI | 1093134835 |
---|---|
Provider Name | Cheryl Moore |
First Address | Palm Harbor, FL 34684-1207 |
Second Address | Palm Harbor, FL 34684-5763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2014 |
Last Update Date | 19/11/2014 |