Healthcare Provider Details

I. General information

NPI: 1912089137
Provider Name (Legal Business Name): GAYLE ANN MOORE-LISI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

4973 DUBLIN DR
NORTH ROYALTON OH
44133-2153
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-2393
  • Fax:
Mailing address:
  • Phone: 440-237-4919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License NumberRN162336
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: