Provider Demographics
NPI:1285784322
Name:MOORE, DANIELLE DANYELLE (LPN)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:DANYELLE
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 1:2400 ORANGE AVE
Mailing Address - Street 2:#94096
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-9003
Mailing Address - Country:US
Mailing Address - Phone:216-269-0330
Mailing Address - Fax:
Practice Address - Street 1:2400 ORANGE AVE
Practice Address - Street 2:#94096
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44101-9003
Practice Address - Country:US
Practice Address - Phone:216-269-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN097093164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2179182Medicaid