MEDICARE: EATHEL ANTOINETTE MOORE CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide		IL

General Provider Information

NPI Number	:	1144177478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EATHEL ANTOINETTE MOORE CNA

Provider Business Mailing Address
First Line	:	1668 W JUNEWAY TER APT 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-1131
Country	:	US
Telephone Number	:	224-714-8838
Fax Number	:

Provider Business Practice Location Address
First Line	:	1668 W JUNEWAY TER APT 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-1131
Country	:	US
Telephone Number	:	224-714-8838
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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