Provider Demographics
NPI:1861631913
Name:MOORE, FELIX CLIFFORD (LPN)
Entity type:Individual
Prefix:MR
First Name:FELIX
Middle Name:CLIFFORD
Last Name:MOORE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3657 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45217-2101
Mailing Address - Country:US
Mailing Address - Phone:513-751-6949
Mailing Address - Fax:513-221-0098
Practice Address - Street 1:3657 CANYON DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45217-2101
Practice Address - Country:US
Practice Address - Phone:513-751-6949
Practice Address - Fax:513-221-0098
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH129246164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse