Provider Demographics
NPI:1235902206
Name:MOORE, LOTTIE M
Entity Type:Individual
Prefix:
First Name:LOTTIE
Middle Name:M
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 1:6725 KINGSLAND CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-7866
Mailing Address - Country:US
Mailing Address - Phone:804-519-4453
Mailing Address - Fax:
Practice Address - Street 1:6725 KINGSLAND CREEK DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-7866
Practice Address - Country:US
Practice Address - Phone:804-519-4453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide