Provider Demographics
NPI:1679893499
Name:MOORE, TISHA CHRISTINE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:TISHA
Middle Name:CHRISTINE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 SIERRA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2854
Mailing Address - Country:US
Mailing Address - Phone:530-343-9032
Mailing Address - Fax:530-343-9302
Practice Address - Street 1:1074 SIERRA VISTA WAY
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2854
Practice Address - Country:US
Practice Address - Phone:530-343-9032
Practice Address - Fax:530-343-9302
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN162330164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse