MEDICARE: MS. DANIELLE DANYELLE MOORE LPN

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	164W00000X	Licensed Practical Nurse	PN097093	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285784322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE DANYELLE MOORE LPN

Provider Business Mailing Address
First Line	:	2400 ORANGE AVE
Second Line	:	#94096
City	:	CLEVELAND
State	:	OH
Zip	:	44101-9003
Country	:	US
Telephone Number	:	216-269-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 ORANGE AVE
Second Line	:	#94096
City	:	CLEVELAND
State	:	OH
Zip	:	44101-9003
Country	:	US
Telephone Number	:	216-269-0330
Fax Number	:

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	03/14/2016

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