Provider Demographics
NPI:1922822972
Name:MOORE, OLIVIA ELIZABETH (LPN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ELIZABETH
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 VILLAGE II DRIVE
Mailing Address - Street 2:D
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468
Mailing Address - Country:US
Mailing Address - Phone:585-694-5564
Mailing Address - Fax:
Practice Address - Street 1:150 STATE ST STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14614-1353
Practice Address - Country:US
Practice Address - Phone:585-454-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348694-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse