Provider Demographics
NPI:1003541228
Name:MOORE HEALTH AND NUTRITION SOLUTIONS
Entity Type:Organization
Organization Name:MOORE HEALTH AND NUTRITION SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEJUAN
Authorized Official - Middle Name:JP
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RD, RDN
Authorized Official - Phone:336-609-0963
Mailing Address - Street 1:415 PISGAH CHURCH ROAD PMB 321
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2590
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4528 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-2815
Practice Address - Country:US
Practice Address - Phone:336-609-0963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty