MEDICARE: ILEANA MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1194489625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILEANA MOORE

Provider Business Mailing Address
First Line	:	407 N COAST HWY STE 300
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-3117
Country	:	US
Telephone Number	:	503-390-5637
Fax Number	:	541-264-7515

Provider Business Practice Location Address
First Line	:	407 N COAST HWY STE 300
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-3117
Country	:	US
Telephone Number	:	503-390-5637
Fax Number	:	541-264-7515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2021
Last Update Date	:	10/30/2021

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Directions to “ ILEANA MOORE ” Practice Location

Language	Start Address	Practice Location

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