Provider Demographics
NPI:1093019796
Name:MOORE, LINDA LEE (CNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 3RD ST. N.E.
Mailing Address - Street 2:P.O. BOX 463
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-1717
Mailing Address - Country:US
Mailing Address - Phone:319-327-0092
Mailing Address - Fax:
Practice Address - Street 1:1717 3RD ST. N.E.
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-1717
Practice Address - Country:US
Practice Address - Phone:319-327-0092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC060293172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker