Individual
DESHAWNA LANIECE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
INDEPENDENT PROVIDER
Contact information
Practice address
2041 HAMPSTEAD DR S, COLUMBUS, OH 43229-2760
(614) 916-6314
Mailing address
2041 HAMPSTEAD DR S, COLUMBUS, OH 43229-2760
(614) 916-6314
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
374U00000X
Home Health Aide
Primary
—
—
376J00000X
Homemaker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000190120
SUPPLIER ID
OH
05
—
0082958
—
OH
Enumeration date
02/12/2019
Last updated
02/12/2019
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