Tanisha Moore

NPI #1558069542 in Wilmette, Illinois

Provider Information

NPI Number: 1558069542
Entity Type: Individual
Name: Tanisha Moore
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Enumeration Date: Feb 20, 2023
Last Updated: Jul 23, 2024

Practice Location

Address: 311A RIDGE RD APT 113
City: Wilmette
State: Illinois
ZIP Code: 60091-3256
Phone: (267) 505-6106

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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