Provider Demographics
NPI:1194949040
Name:MOORE, DAWN R
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:R
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 1:412 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41183-9437
Mailing Address - Country:US
Mailing Address - Phone:606-922-3296
Mailing Address - Fax:
Practice Address - Street 1:316 MARION PIKE
Practice Address - Street 2:
Practice Address - City:COAL GROVE
Practice Address - State:OH
Practice Address - Zip Code:45638-2957
Practice Address - Country:US
Practice Address - Phone:740-532-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2380061372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider