Provider Demographics
NPI:1336354992
Name:MOORE, CHIEMI LEA (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHIEMI
Middle Name:LEA
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:CHIEMI
Other - Middle Name:LEA
Other - Last Name:WILLARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1592 GRANVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1076
Mailing Address - Country:US
Mailing Address - Phone:740-687-0835
Mailing Address - Fax:740-687-9391
Practice Address - Street 1:1592 GRANVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1076
Practice Address - Country:US
Practice Address - Phone:740-687-0835
Practice Address - Fax:740-687-9391
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN298675163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health