Provider Demographics
NPI:1982432407
Name:MOORE, JENNA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:753 GLENDALE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2249
Mailing Address - Country:US
Mailing Address - Phone:740-538-9304
Mailing Address - Fax:
Practice Address - Street 1:184 HOLIDAY HILLS DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-8006
Practice Address - Country:US
Practice Address - Phone:304-491-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH145191164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse