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General NPI Number Information
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NPI Number | 1487465324
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Entity Type | Individual
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Provider Name | DESTINEY M MOORE
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 972 33RD ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-2435
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Country | US
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Telephone | 646-775-8413
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Fax |
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Provider Business Mailing Address
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Address Line | 763 5TH ST NW # 2
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-5159
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Country | US
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Telephone | 646-775-8413
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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