Provider Demographics
NPI:1417417981
Name:MOORE, SHAWNIQUE (LPN)
Entity Type:Individual
Prefix:PROF
First Name:SHAWNIQUE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 HORIZON DR APT A
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-8725
Mailing Address - Country:US
Mailing Address - Phone:330-431-3101
Mailing Address - Fax:
Practice Address - Street 1:1773 HORIZON DR APT A
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-8725
Practice Address - Country:US
Practice Address - Phone:330-431-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN109154164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN109154OtherOHIO BOARD OF NURSING