Provider Demographics
NPI:1053788919
Name:MOORE, JODIE MARIE
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 UNION ST
Mailing Address - Street 2:P.O. BOX 278
Mailing Address - City:DANSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48819-5124
Mailing Address - Country:US
Mailing Address - Phone:517-488-7505
Mailing Address - Fax:
Practice Address - Street 1:972 UNION ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48819-5124
Practice Address - Country:US
Practice Address - Phone:517-488-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator