Provider Demographics
NPI:1295433704
Name:MOORE, JANELL LA JUNE
Entity type:Individual
Prefix:
First Name:JANELL
Middle Name:LA JUNE
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 1:4654 E AVENUE S STE B-136
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-4454
Mailing Address - Country:US
Mailing Address - Phone:626-625-4196
Mailing Address - Fax:
Practice Address - Street 1:4654 E AVENUE S STE B-136
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4454
Practice Address - Country:US
Practice Address - Phone:626-625-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA725521164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse