Provider Demographics
NPI:1104476183
Name:MOORE, ELIZABETH ANN (ATTENDANT CARE PROVI)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:ATTENDANT CARE PROVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 STONE CIRCLE DRIVE,
Mailing Address - Street 2:
Mailing Address - City:GORDONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76245
Mailing Address - Country:US
Mailing Address - Phone:903-523-5030
Mailing Address - Fax:903-523-4822
Practice Address - Street 1:233 STONE CIRCLE DRIVE
Practice Address - Street 2:
Practice Address - City:GORDONVILLE
Practice Address - State:TX
Practice Address - Zip Code:76245
Practice Address - Country:US
Practice Address - Phone:214-857-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider