Provider Demographics
NPI:1376305797
Name:MOORE, TAMERA K
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:K
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 1:1750 POTTS LN
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-6025
Mailing Address - Country:US
Mailing Address - Phone:740-819-1026
Mailing Address - Fax:740-487-1623
Practice Address - Street 1:1750 POTTS LN
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-6025
Practice Address - Country:US
Practice Address - Phone:740-819-1026
Practice Address - Fax:740-487-1623
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty