Provider Demographics
NPI:1215540232
Name:MOORE, CLARICE
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARISHA
Other - Middle Name:
Other - Last Name:LAMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4220 W PAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-3140
Mailing Address - Country:US
Mailing Address - Phone:314-701-0257
Mailing Address - Fax:314-925-8407
Practice Address - Street 1:4220 W PAGE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-3140
Practice Address - Country:US
Practice Address - Phone:314-701-0257
Practice Address - Fax:314-925-8407
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
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