Provider Demographics
NPI:1063117422
Name:MOORE, HANNAH ELLEN (RD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ELLEN
Last Name:MOORE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 HICKORY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013-2745
Mailing Address - Country:US
Mailing Address - Phone:177-544-0836
Mailing Address - Fax:
Practice Address - Street 1:2605 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1548
Practice Address - Country:US
Practice Address - Phone:777-754-4083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered