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NPI Code Detail

MEDICARE: MS. TRACEY RENEE MOORE LPN

MEDICARE: MS. TRACEY RENEE MOORE LPN
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
1164W00000XLicensed Practical NurseLPN.129245.MEDSOH

General Provider Information

NPI Number : 1730329962
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACEY RENEE MOORE LPN
Provider Business Mailing Address
First Line : 830 EZZARD CHARLES DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45214-2525
Country : US
Telephone Number : 513-381-6672
Fax Number :
Provider Business Practice Location Address
First Line : 830 EZZARD CHARLES DR
Second Line :
City : CINCINNATI
State : OH
Zip : 45214-2525
Country : US
Telephone Number : 513-381-6672
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2009
Last Update Date : 09/17/2023

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