Provider Demographics
NPI:1497531602
Name:MOORER, RICKELL SHANTELL
Entity Type:Individual
Prefix:
First Name:RICKELL
Middle Name:SHANTELL
Last Name:MOORER
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 1:918 SPRING RD APT 162
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4470
Mailing Address - Country:US
Mailing Address - Phone:216-400-2364
Mailing Address - Fax:
Practice Address - Street 1:918 SPRING RD APT 162
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4470
Practice Address - Country:US
Practice Address - Phone:216-400-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide