MEDICARE: TERRYL LYNN OLIVER MOORE II 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	347697	NY

General Provider Information

NPI Number	:	1346009578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRYL LYNN OLIVER MOORE II LPN

Provider Business Mailing Address
First Line	:	147 CHARWOOD CIR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-2718
Country	:	US
Telephone Number	:	585-748-8509
Fax Number	:

Provider Business Practice Location Address
First Line	:	147 CHARWOOD CIR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-2718
Country	:	US
Telephone Number	:	585-748-8509
Fax Number	:

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

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	03/18/2024

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