Provider Demographics
NPI:1104654136
Name:MOORE-ROSE, RYAN DANAE
Entity type:Individual
Prefix:MS
First Name:RYAN
Middle Name:DANAE
Last Name:MOORE-ROSE
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 1:403 GRINNELL ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7979
Mailing Address - Country:US
Mailing Address - Phone:614-600-4887
Mailing Address - Fax:
Practice Address - Street 1:403 GRINNELL ST
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7979
Practice Address - Country:US
Practice Address - Phone:614-600-4887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide