Provider Demographics
NPI:1033350467
Name:MOORE, ROSALIND (NURSE)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIND
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11918 WINSTON CIR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1534
Mailing Address - Country:US
Mailing Address - Phone:513-851-1141
Mailing Address - Fax:
Practice Address - Street 1:3559 READING RD STE 101
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-2689
Practice Address - Country:US
Practice Address - Phone:513-357-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN251378163WS0200X
OHAPRN.CNP024101363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1033350467Medicaid