Provider Demographics
NPI:1558999839
Name:MOORE, SARAH JEAN (LCPM, LM, CPM, BSM)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JEAN
Last Name:MOORE
Suffix:
Gender:
Credentials:LCPM, LM, CPM, BSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-8923
Mailing Address - Country:US
Mailing Address - Phone:309-721-1377
Mailing Address - Fax:309-322-6466
Practice Address - Street 1:2312 5TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8923
Practice Address - Country:US
Practice Address - Phone:309-721-1377
Practice Address - Fax:309-322-6466
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI285-49176B00000X
IACPM0005176B00000X
IL295.000007176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife