Provider Demographics
NPI:1679502181
Name:MOORE, SIMONA LYDIA (CNP)
Entity type:Individual
Prefix:
First Name:SIMONA
Middle Name:LYDIA
Last Name:MOORE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S MULBERRY ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-3331
Mailing Address - Country:US
Mailing Address - Phone:330-473-2569
Mailing Address - Fax:740-326-1175
Practice Address - Street 1:206 S MULBERRY ST STE A
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3331
Practice Address - Country:US
Practice Address - Phone:330-473-2569
Practice Address - Fax:740-326-1175
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.232279-COA1363LF0000X
OHNP4502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2271796Medicaid
OH2271796Medicaid
OHH173331Medicare PIN