Provider Demographics
NPI:1215537261
Name:MOORE, SYLVIA KAYE (QSP)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:KAYE
Last Name:MOORE
Suffix:
Gender:F
Credentials:QSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN
Mailing Address - State:ND
Mailing Address - Zip Code:58262-0111
Mailing Address - Country:US
Mailing Address - Phone:701-993-8370
Mailing Address - Fax:701-993-8370
Practice Address - Street 1:60 MOORE LANE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN
Practice Address - State:ND
Practice Address - Zip Code:58262-0111
Practice Address - Country:US
Practice Address - Phone:701-993-8370
Practice Address - Fax:701-993-8370
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND17866374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide