Provider Information for 1487154803
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MONICA L MOORE
Sex: Female
NPI: 1487154803
Last Updated: 2021-07-28
Certification Date: 2021-07-28
Certification Date: 2021-07-28
Details
| Name | Value | ||||||||||||
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| NPI | 1487154803 | ||||||||||||
| Enumeration Date | 2018-02-13 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 2055 JAMESTOWN, ND 58402-2055 United States Phone: 701-253-6300 | Fax: | ||||||||||||
| Primary Practice Address | 520 3RD ST NW JAMESTOWN, ND 58401-2968 United States Phone: 701-253-6308 | Fax: | ||||||||||||
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