Provider Information for 1902536584
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KIMBERLY MOORER
Sex: Female
NPI: 1902536584
Last Updated: 2022-06-15
Certification Date: 2022-06-15
Certification Date: 2022-06-15
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1902536584 | ||||||||||||||
| Enumeration Date | 2022-06-15 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 1031 MARYLAND AVE UNIT 230 SHEBOYGAN, WI 53081-4911 United States Phone: 414-263-8281 | Fax: | ||||||||||||||
| Primary Practice Address | 805 N 6TH ST SHEBOYGAN, WI 53081-4113 United States Phone: 920-457-8866 | Fax: | ||||||||||||||
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