Provider Demographics
NPI:1730468844
Name:MOORE, ANDREA SUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:SUE
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 1:1669 MOON RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-8227
Mailing Address - Country:US
Mailing Address - Phone:740-463-6056
Mailing Address - Fax:
Practice Address - Street 1:1669 MOON RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-8227
Practice Address - Country:US
Practice Address - Phone:740-463-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-06
Last Update Date:2011-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112938164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse