Individual
MRS. DONNA M MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
459 MILL ST, CONNEAUT, OH 44030-2454
(440) 593-1361
(440) 599-9931
Mailing address
459 MILL ST, CONNEAUT, OH 44030-2454
(440) 593-1361
(440) 599-9931
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 077951
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104228533699
—
OH
Enumeration date
03/06/2007
Last updated
07/08/2007
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