MEDICARE: DR. SARAH B MOORE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC2100X	Continence Care Registered Nurse	4704237785	MI

General Provider Information

NPI Number	:	1184380768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH B MOORE RN

Provider Business Mailing Address
First Line	:	12050 ALBEE RD
Second Line	:
City	:	BURT
State	:	MI
Zip	:	48417-9664
Country	:	US
Telephone Number	:	248-390-0165
Fax Number	:

Provider Business Practice Location Address
First Line	:	12050 ALBEE RD
Second Line	:
City	:	BURT
State	:	MI
Zip	:	48417-9664
Country	:	US
Telephone Number	:	248-390-0165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/09/2021

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Directions to “ DR. SARAH B MOORE RN” Practice Location

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