Provider Demographics
NPI:1871823393
Name:MOORE, JODI MARIE (CD(DONA))
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 CEDAR WALK CIR NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4456
Mailing Address - Country:US
Mailing Address - Phone:706-523-6715
Mailing Address - Fax:
Practice Address - Street 1:177 CEDAR WALK CIR NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4456
Practice Address - Country:US
Practice Address - Phone:706-523-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula