Individual
LISA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
2765 BRAMBLEBUSH CT, COLUMBUS, OH 43224-2505
(614) 493-1301
Mailing address
2765 BRAMBLEBUSH CT, COLUMBUS, OH 43224-2505
(614) 493-1301
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
400844851208
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2810962
—
OH
Enumeration date
07/07/2014
Last updated
07/07/2014
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