Provider Demographics
NPI:1932730553
Name:MOORE, JANEQUIA
Entity Type:Individual
Prefix:
First Name:JANEQUIA
Middle Name:
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 1:5348 OLD JACKSONVILLE HWY APT 1413
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3368
Mailing Address - Country:US
Mailing Address - Phone:936-332-4667
Mailing Address - Fax:
Practice Address - Street 1:5348 OLD JACKSONVILLE HWY APT 1413
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3368
Practice Address - Country:US
Practice Address - Phone:936-332-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse