Moore, Tamela A

Moore, Tamela A is an individual health care provider with primary practice located at 2202 Harlem Road , Loves Park IL 61111-2754. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Moore, Tamela A can be contacted via phone (815) 877-4848.

Contact Information

Primary practice address
2202 Harlem Road Loves Park IL 61111-2754
Phone: (815) 877-4848
Fax: (815) 636-6125
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 209.020399 Illinois

Profile Details

NPI number 1902856081
LBN Legal business name Moore, Tamela A
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2006
Last updated Jan 17th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902856081 NPPES
Alabama Other 51514781 BLUE SHIELD
Alabama Other P00016930 BLUE SHIELD
Alabama MEDICAID 051514781 BLUE SHIELD

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