MEDICARE: LATOSHA MOORE

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	163W00000X	Registered Nurse	RN.451264	OH

General Provider Information

NPI Number	:	1215586813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOSHA MOORE

Provider Business Mailing Address
First Line	:	1929 DE ARMAND AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-4725
Country	:	US
Telephone Number	:	513-302-3460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1929 DE ARMAND AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-4725
Country	:	US
Telephone Number	:	513-302-3460
Fax Number	:

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

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	09/06/2019

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Directions to “ LATOSHA MOORE ” Practice Location

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