Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1306227749 |
---|---|
Provider Name | Janice Moore |
First Address | Lakeland, FL 33803-2862 |
Second Address | Lakeland, FL 33803-2862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 11/06/2015 |