Provider Demographics
NPI:1801926464
Name:MOORE, CYNTHIA HONEY DELORSE (LPN)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:HONEY DELORSE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14116 BARDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3704
Mailing Address - Country:US
Mailing Address - Phone:216-254-6077
Mailing Address - Fax:216-681-6020
Practice Address - Street 1:14116 BARDWELL AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-3704
Practice Address - Country:US
Practice Address - Phone:216-254-6077
Practice Address - Fax:216-681-6020
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 072263164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse