Provider Demographics
NPI:1366113474
Name:MOORE, LAURA (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 S LAZELLE ST APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-1127
Mailing Address - Country:US
Mailing Address - Phone:609-744-1881
Mailing Address - Fax:
Practice Address - Street 1:1214 S SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80232-8022
Practice Address - Country:US
Practice Address - Phone:303-233-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996874-NP363LF0000X
CORN.1676642163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse