Provider Demographics
NPI:1447409040
Name:MOORE, REDA VIOLET (LPN)
Entity Type:Individual
Prefix:
First Name:REDA
Middle Name:VIOLET
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 1:3343 EVERSON RD E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5926
Mailing Address - Country:US
Mailing Address - Phone:614-515-0468
Mailing Address - Fax:614-829-3129
Practice Address - Street 1:3343 EVERSON ROAD EAST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-5926
Practice Address - Country:US
Practice Address - Phone:614-515-0468
Practice Address - Fax:614-829-3129
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112737164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse