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General NPI Number Information
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NPI Number | 1679502181
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Entity Type | Individual
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Provider Name | SIMONA LYDIA MOORE C.N.P.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 206 S MULBERRY ST STE A
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City | MOUNT VERNON
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State | OH
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Zip | 43050-3331
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Country | US
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Telephone | 330-473-2569
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Fax | 740-326-1175
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Provider Business Mailing Address
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Address Line | 206 S MULBERRY ST STE A
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City | MOUNT VERNON
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State | OH
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Zip | 43050-3331
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Country | US
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Telephone | 740-326-1231
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Fax | 740-326-1175
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN.232279-COA1
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP4502
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License Number State | OH
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