Provider Demographics
NPI:1083904031
Name:MOORE, JOYCE LYNNELL
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:LYNNELL
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 BURRINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6471
Mailing Address - Country:US
Mailing Address - Phone:252-531-3150
Mailing Address - Fax:252-355-4041
Practice Address - Street 1:448 BURRINGTON ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6471
Practice Address - Country:US
Practice Address - Phone:252-531-3150
Practice Address - Fax:252-355-4041
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00017132SC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)