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General NPI Number Information
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NPI Number | 1982432407
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Entity Type | Individual
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Provider Name | JENNA MARIE MOORE LPN
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Gender | Female
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Dates
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Enumeration Date | 07/25/2024
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 184 HOLIDAY HILLS DR
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City | PARKERSBURG
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State | WV
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Zip | 26104-8006
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Country | US
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Telephone | 304-491-4082
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Fax |
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Provider Business Mailing Address
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Address Line | 753 GLENDALE RD APT 2
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City | MARIETTA
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State | OH
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Zip | 45750-2249
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Country | US
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Telephone | 740-538-9304
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 145191
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License Number State | OH
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