Individual
JACKEE NIKITA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3271 LODWICK DR NW, APT 4, WARREN, OH 44485-1565
(330) 240-8366
Mailing address
3271 LODWICK DR NW, APT 4, WARREN, OH 44485-1565
(330) 240-8366
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0115639
—
OH
Enumeration date
04/20/2015
Last updated
04/20/2015
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