Provider Demographics
NPI:1902418775
Name:MOORE, DELLA JEAN
Entity Type:Individual
Prefix:
First Name:DELLA
Middle Name:JEAN
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 1:1026 VINSON ST APT 21
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3351
Mailing Address - Country:US
Mailing Address - Phone:304-928-0946
Mailing Address - Fax:
Practice Address - Street 1:1026 VINSON ST APT 21
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3351
Practice Address - Country:US
Practice Address - Phone:304-928-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant