Provider Demographics
NPI:1093104010
Name:MOORE, CAPRICE (CNA)
Entity Type:Individual
Prefix:
First Name:CAPRICE
Middle Name:
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 1:4616 N HYDRAULIC ST
Mailing Address - Street 2:APT. 611
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219-2900
Mailing Address - Country:US
Mailing Address - Phone:316-299-1347
Mailing Address - Fax:
Practice Address - Street 1:1319 S. SEVILLE
Practice Address - Street 2:DESERET AT SEVILLE
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2900
Practice Address - Country:US
Practice Address - Phone:316-722-6916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS176002376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide