Provider Demographics
NPI:1730586272
Name:MOORE, LILLIAN GAY (RN)
Entity type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:GAY
Last Name:MOORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:OREGONIA
Mailing Address - State:OH
Mailing Address - Zip Code:45054-9801
Mailing Address - Country:US
Mailing Address - Phone:513-659-9014
Mailing Address - Fax:
Practice Address - Street 1:5709 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:OREGONIA
Practice Address - State:OH
Practice Address - Zip Code:45054-9801
Practice Address - Country:US
Practice Address - Phone:513-659-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-27
Last Update Date:2014-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN321766163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse