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General NPI Number Information
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NPI Number | 1346042512
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Entity Type | Individual
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Provider Name | MICKALLA MOORE LVN
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Gender | Female
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 1901 BARNEY RD
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City | ANDERSON
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State | CA
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Zip | 96007-4301
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Country | US
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Telephone | 530-410-2290
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 VICTOR AVE APT 50
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City | REDDING
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State | CA
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Zip | 96003-4050
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Country | US
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Telephone | 530-410-2290
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Fax |
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 740224
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License Number State | CA
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