Provider Demographics
NPI:1700645850
Name:MOORE, RENEE L
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:L
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 1:433 N WOOSTER WAY NW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9236
Mailing Address - Country:US
Mailing Address - Phone:740-438-8638
Mailing Address - Fax:
Practice Address - Street 1:433 N WOOSTER WAY NW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-9236
Practice Address - Country:US
Practice Address - Phone:740-438-8638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health