Provider Demographics
NPI:1457538258
Name:MOORE - SPENCER, DRESDEN S (RN)
Entity Type:Individual
Prefix:MS
First Name:DRESDEN
Middle Name:S
Last Name:MOORE - SPENCER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 NO NAME RD
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9736
Mailing Address - Country:US
Mailing Address - Phone:740-289-8171
Mailing Address - Fax:
Practice Address - Street 1:188 NO NAME RD
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9736
Practice Address - Country:US
Practice Address - Phone:740-289-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN228686163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse