Provider Demographics
NPI:1003799107
Name:MOORE, ALICIA PHILANA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:PHILANA
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 1:4205 CIRCLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6523
Mailing Address - Country:US
Mailing Address - Phone:419-870-7764
Mailing Address - Fax:
Practice Address - Street 1:4205 CIRCLEVIEW DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6523
Practice Address - Country:US
Practice Address - Phone:419-870-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker