Provider Demographics
NPI:1184962664
Name:MOORE, ABBY JO (CD)
Entity type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:JO
Last Name:MOORE
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GRAYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62844-1016
Mailing Address - Country:US
Mailing Address - Phone:618-518-9099
Mailing Address - Fax:
Practice Address - Street 1:840 N 1ST ST
Practice Address - Street 2:
Practice Address - City:GRAYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62844-1016
Practice Address - Country:US
Practice Address - Phone:618-518-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula