Provider Demographics
NPI:1801389937
Name:MOORE, ASHLEE MARIE (NURSE)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 GLENCROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-3361
Mailing Address - Country:US
Mailing Address - Phone:513-827-9044
Mailing Address - Fax:
Practice Address - Street 1:3448 MILLRICH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-6144
Practice Address - Country:US
Practice Address - Phone:513-850-6237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.156124.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse