Healthcare Provider Details

I. General information

NPI: 1053229153
Provider Name (Legal Business Name): MONIQUE MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 STARGRASS RD
OMAHA NE
68152-5207
US

IV. Provider business mailing address

5716 N 35TH ST
OMAHA NE
68111-1508
US

V. Phone/Fax

Practice location:
  • Phone: 402-515-4874
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: