Provider Demographics
NPI:1821381047
Name:MOORE, DANETHA D (LPN)
Entity Type:Individual
Prefix:MISS
First Name:DANETHA
Middle Name:D
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 1:22110 RIVER OAKS DR APT 3C
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3107
Mailing Address - Country:US
Mailing Address - Phone:216-854-4450
Mailing Address - Fax:
Practice Address - Street 1:22110 RIVER OAKS DR APT 3C
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3107
Practice Address - Country:US
Practice Address - Phone:216-854-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH137577164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse