Provider Demographics
NPI:1952032633
Name:MOORE, TANEISHA
Entity Type:Individual
Prefix:
First Name:TANEISHA
Middle Name:
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 1:22829 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:STEGER
Mailing Address - State:IL
Mailing Address - Zip Code:60475-5933
Mailing Address - Country:US
Mailing Address - Phone:773-370-3726
Mailing Address - Fax:773-352-9492
Practice Address - Street 1:2829 W 87TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1135
Practice Address - Country:US
Practice Address - Phone:773-370-3726
Practice Address - Fax:773-352-9492
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other