MEDICARE: MRS. VALERIE L MOORE RN

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	PN115218	OH
2	163W00000X	Registered Nurse	396569	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	:	1740493238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VALERIE L MOORE RN

Provider Business Mailing Address
First Line	:	14519 TOKAY AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3844
Country	:	US
Telephone Number	:	216-376-4784
Fax Number	:

Provider Business Practice Location Address
First Line	:	14519 TOKAY AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3844
Country	:	US
Telephone Number	:	216-376-4784
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	12/04/2013

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