Provider Demographics
NPI:1497558068
Name:MOORE, JAQUANIE RENEE
Entity type:Individual
Prefix:
First Name:JAQUANIE
Middle Name:RENEE
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 1:2433 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3422
Mailing Address - Country:US
Mailing Address - Phone:402-318-6448
Mailing Address - Fax:402-318-6448
Practice Address - Street 1:4945 WALKER AVE APT 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68504-2837
Practice Address - Country:US
Practice Address - Phone:402-730-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant