Provider Demographics
NPI:1003022104
Name:MOXLEY, DOROTHEA MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHEA
Middle Name:MARIE
Last Name:MOXLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DOROTHEA
Other - Middle Name:MARIE
Other - Last Name:INGRAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:39 N OTTERBEIN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-1707
Mailing Address - Country:US
Mailing Address - Phone:614-674-3816
Mailing Address - Fax:
Practice Address - Street 1:39 N OTTERBEIN AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081
Practice Address - Country:US
Practice Address - Phone:614-674-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH113195164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse