Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN.324296 | OH |
NPI | 1639602659 |
---|---|
Provider Name | Darci Moore |
First Address | Washington Court House, OH 43160-1199 |
Second Address | Washington Court House, OH 43160-2235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2017 |
Last Update Date | 06/04/2017 |