Provider Demographics
NPI:1538287354
Name:MOORE, VANESSA KAY
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:KAY
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 1:901 WILLOW BROOK CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-8023
Mailing Address - Country:US
Mailing Address - Phone:937-902-0557
Mailing Address - Fax:
Practice Address - Street 1:901 WILLOW BROOK CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-8023
Practice Address - Country:US
Practice Address - Phone:937-902-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide