Provider Demographics
NPI:1902481617
Name:MOORE, VIRGINIA ELIZABETH
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ELIZABETH
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 1:622 MATTHEWS RD APT 5
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-1143
Mailing Address - Country:US
Mailing Address - Phone:304-646-2362
Mailing Address - Fax:
Practice Address - Street 1:622 MATTHEWS RD APT 5
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1143
Practice Address - Country:US
Practice Address - Phone:304-646-2362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant