Provider Demographics
NPI:1851183008
Name:MOORE, JELANI
Entity type:Individual
Prefix:
First Name:JELANI
Middle Name:
Last Name:MOORE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 RIDGEMOOR DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-1636
Mailing Address - Country:US
Mailing Address - Phone:616-337-1332
Mailing Address - Fax:
Practice Address - Street 1:2611 RIDGEMOOR DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-1636
Practice Address - Country:US
Practice Address - Phone:616-337-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula