Provider Information for 1356370605
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BRENDA MOORE
Sex: Female
NPI: 1356370605
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1356370605 | ||||||||
| Enumeration Date | 2006-06-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2205 EIDER CT GRAHAM, NC 27253-8800 United States Phone: 919-405-2177 | Fax:919-544-4611 | ||||||||
| Primary Practice Address | 1906 HWY. 54 SUITE 200 DURHAM, NC 27713 United States Phone: 919-405-2177 | Fax:919-544-4611 | ||||||||
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