Provider Demographics
NPI:1306057278
Name:MOORE, SHENARRA NICOLE (HOME HEALTH CARE PRO)
Entity type:Individual
Prefix:MS
First Name:SHENARRA
Middle Name:NICOLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:HOME HEALTH CARE PRO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 ROSA PARKS DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1414
Mailing Address - Country:US
Mailing Address - Phone:216-761-7142
Mailing Address - Fax:
Practice Address - Street 1:1364 ROSA PARKS DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1414
Practice Address - Country:US
Practice Address - Phone:216-761-7142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN440100171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2723780Medicaid