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General NPI Number Information
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NPI Number | 1013042514
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Entity Type | Individual
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Provider Name | WANDA D MOORE DME
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Gender | Female
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2213 N LIMESTONE ST
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City | SPRINGFIELD
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State | OH
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Zip | 45503-2635
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Country | US
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Telephone | 937-399-6477
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Fax |
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Provider Business Mailing Address
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Address Line | 2213 N LIMESTONE ST
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City | SPRINGFIELD
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State | OH
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Zip | 45503-2635
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Country | US
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Telephone | 937-399-6477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | NA
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License Number State |
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