Provider Demographics
NPI:1841598455
Name:MOORE, ELIZABETH MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:CRABTREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:899 BARKS AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-7182
Mailing Address - Country:US
Mailing Address - Phone:740-382-5317
Mailing Address - Fax:
Practice Address - Street 1:899 BARKS AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7182
Practice Address - Country:US
Practice Address - Phone:740-382-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN131531164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse