Provider Demographics
NPI:1326249798
Name:MOORE, RACHAEL YVONNE
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:YVONNE
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 1:1760 NAVION COURT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119
Mailing Address - Country:US
Mailing Address - Phone:614-922-9095
Mailing Address - Fax:
Practice Address - Street 1:CARE STAN 6100 CHANNINGWAY BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232
Practice Address - Country:US
Practice Address - Phone:614-251-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN041669374U00000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse