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General NPI Number Information
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NPI Number | 1316188493
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Entity Type | Individual
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Provider Name | LOIS B MOORE CNA / CTS
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Gender | Female
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 5306 S HOYNE AVE
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City | CHICAGO
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State | IL
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Zip | 60609-5543
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Country | US
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Telephone | 773-603-0644
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Fax | 773-471-3222
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Provider Business Mailing Address
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Address Line | 5306 S HOYNE AVE
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City | CHICAGO
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State | IL
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Zip | 60609-5543
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Country | US
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Telephone | 773-603-0644
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Fax | 773-471-3222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number | 208269611
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License Number State | IL
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