Provider Demographics
NPI:1740739143
Name:MOORE, LINDA LEE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
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 1:3830 HIGGINS ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4960
Mailing Address - Country:US
Mailing Address - Phone:970-219-6822
Mailing Address - Fax:970-682-6494
Practice Address - Street 1:3830 HIGGINS ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4960
Practice Address - Country:US
Practice Address - Phone:970-219-6822
Practice Address - Fax:970-682-6494
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMP.00179558171WH0202X
COPC.0001540171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications