Provider Demographics
NPI:1811494586
Name:MOORE, SHAREE LYNETTE (LPN)
Entity type:Individual
Prefix:
First Name:SHAREE
Middle Name:LYNETTE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13929 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3672
Mailing Address - Country:US
Mailing Address - Phone:313-371-0055
Mailing Address - Fax:313-371-1409
Practice Address - Street 1:647 ARDEN PARK BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1303
Practice Address - Country:US
Practice Address - Phone:313-208-4836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703092686164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse