Healthcare Provider Details

I. General information

NPI: 1033350467
Provider Name (Legal Business Name): ROSALIND MOORE NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2009
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3559 READING RD STE 101
CINCINNATI OH
45229-2689
US

IV. Provider business mailing address

11918 WINSTON CIR
CINCINNATI OH
45240-1534
US

V. Phone/Fax

Practice location:
  • Phone: 513-357-7300
  • Fax:
Mailing address:
  • Phone: 513-851-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN251378
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP024101
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: