Provider Demographics
NPI:1538332044
Name:MOORE, JACQUELINE LEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:LEE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:317 BROADWAY
Mailing Address - Street 2:PLANNED PARENTHOOD OF SOUTHERN NEW JERSEY
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103
Mailing Address - Country:US
Mailing Address - Phone:856-365-3519
Mailing Address - Fax:856-365-9215
Practice Address - Street 1:317 BROADWAY
Practice Address - Street 2:PLANNED PARENTHOOD OF SOUTHERN NEW JERSEY
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103
Practice Address - Country:US
Practice Address - Phone:856-365-3519
Practice Address - Fax:856-365-9215
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05991800164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse