Provider Demographics
NPI:1649814021
Name:MOORE, ZACHARY ANDREW-VERNON (RN)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:ANDREW-VERNON
Last Name:MOORE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7139 N SPRINGBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3605
Mailing Address - Country:US
Mailing Address - Phone:937-844-7362
Mailing Address - Fax:
Practice Address - Street 1:7139 N SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3605
Practice Address - Country:US
Practice Address - Phone:937-844-7362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2021-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.163919.MEDS-IV164W00000X
OHRN.488740163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No164W00000XNursing Service ProvidersLicensed Practical Nurse