Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 71009428A | IN |
NPI | 1003467218 |
---|---|
Provider Name | Elizabeth Victoria Moerman |
First Address | Knox, IN 46534-1619 |
Second Address | Knox, IN 46534-8226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2019 |
Last Update Date | 28/09/2019 |